FLORIDA
The University of Miami agreed to pay $22 million to resolve allegations that it violated the False Claims Act by ordering medically unnecessary laboratory tests, and submitting false claims through its laboratory and off-campus hospital-based facilities, officials stated.
According to court documents, the federal government alleged that UM engaged in three practices that violated the False Claims Act.
First, the government alleged that UM knowingly engaged in improper billing relating to its Hospital Facilities. Medicare regulations allow medical systems to convert physician offices into Hospital Facilities provided they satisfy certain requirements.
Billing as a Hospital Facility results in higher costs to the Medicare program and beneficiaries.
Hospital Facilities are required to give notice to Medicare beneficiaries that explain the financial ramifications of receiving services at Hospital Facilities as opposed to physician offices.
The government alleged that UM converted multiple physician offices to Hospital Facilities.
Then, they sought payment at higher rates without providing beneficiaries the required notice, even after being advised by a Medicare Administrative Contractor that its notice practices were deficient.
Second, the government alleged that UM billed federal health care programs for medically unnecessary laboratory tests for patients who received kidney transplants at the Miami Transplant Institute (MTI) — a transplant program operated by UM and Jackson Memorial Hospital (JMH).
Each time a patient checked into the MTI, UM’s electronic ordering system triggered a pre-set “protocol” of tests to be run for the patient at UM’s laboratory, according to officials.
The government alleged that several tests on the protocol for all kidney transplant patients were medically unnecessary and dictated by financial considerations rather than patient care.
Third, the government alleged that UM caused JMH to submit inflated claims for reimbursement for pre-transplant laboratory testing conducted at the MTI in violation of related party regulations, which limit the reimbursement a provider can obtain for tests performed by a related entity to that entity’s actual costs.
The government alleged that UM did so by controlling JMH’s decision to purchase pre-transplant laboratory tests from UM at inflated rates in exchange for UM’s surgeons and Department of Surgery continuing to perform surgeries at JMH. In a separate agreement, the United States has reached a $1.1 million settlement with JMH relating to this conduct.
“Medical providers who submit fraudulent claims to our taxpayer-funded health care programs not only violate the public’s trust, they compromise the very integrity of these programs,” said Acting U.S. Attorney Juan Antonio Gonzalez for the Southern District of Florida. “Our office will aggressively pursue investigations against all providers who knowingly violate these billing rules no matter their size.”
“Bilking the Medicare program and patients by charging for medically unnecessary services will always draw the attention of my office,” said Special Agent in Charge Omar Pérez Aybar of the Department of Health and Human Services Office of Inspector General (HHS-OIG).
Contemporaneous with the civil settlement, UM has also agreed to enter into a corporate integrity agreement with the Department of Health and Human Services.
The civil settlement resolves allegations made in three lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act.
The law allows private individuals to sue on behalf of the government for false claims and to share in any recovery. The whistleblower’s share of the recovery, in this case, has not yet been determined.