{"id":42690,"date":"2021-05-11T21:33:29","date_gmt":"2021-05-12T04:33:29","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=42690"},"modified":"2021-05-11T21:35:59","modified_gmt":"2021-05-12T04:35:59","slug":"u-of-miami-to-pay-22-million-to-settle-claims-of-fraudulent-billing-practices","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=42690","title":{"rendered":"U of Miami to Pay $22 Million to Settle Claims of Fraudulent Billing Practices"},"content":{"rendered":"

FLORIDA<\/span><\/strong><\/p>\n

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.<\/span><\/p>\n

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\"\"<\/a>According to court documents, the federal government alleged that UM engaged in three practices that violated the False Claims Act. <\/span><\/p>\n

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. <\/span><\/p>\n

Billing as a Hospital Facility results in higher costs to the Medicare program and beneficiaries. <\/span><\/p>\n

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.<\/span><\/p>\n

\"\"<\/a>The government alleged that UM converted multiple physician offices to Hospital Facilities. <\/span><\/p>\n

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.<\/span><\/p>\n

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) \u2014 a transplant program operated by UM and Jackson Memorial Hospital (JMH). <\/span><\/p>\n

Each time a patient checked into the MTI, UM\u2019s electronic ordering system triggered a pre-set \u201cprotocol\u201d of tests to be run for the patient at UM\u2019s laboratory, according to officials.<\/span><\/p>\n

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.<\/span><\/p>\n

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\u2019s actual costs. <\/span><\/p>\n

The government alleged that UM did so by controlling JMH\u2019s decision to purchase pre-transplant laboratory tests from UM at inflated rates in exchange for UM\u2019s 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.\u00a0<\/span><\/p>\n

\u201cMedical providers who submit fraudulent claims to our taxpayer-funded health care programs not only\u00a0violate the public\u2019s trust, they\u00a0compromise the very integrity of these programs,\u201d said Acting U.S. Attorney Juan Antonio Gonzalez for the Southern District of Florida.\u00a0\u201cOur office will aggressively pursue investigations against all providers who knowingly violate these billing rules no matter their size.\u201d \u00a0\u00a0<\/span><\/p>\n

\u201cBilking the Medicare program and patients by charging for medically unnecessary services will always draw the attention of my office,\u201d said Special Agent in Charge Omar P\u00e9rez Aybar of the Department of Health and Human Services Office of Inspector General (HHS-OIG).\u00a0<\/span><\/p>\n

Contemporaneous with the civil settlement, UM has also agreed to enter into a corporate integrity agreement with the Department of Health and Human Services.<\/span><\/p>\n

The civil settlement resolves allegations made in three lawsuits filed under the\u00a0qui tam,\u00a0<\/i>or whistleblower,<\/i> provisions of the False Claims Act. <\/span><\/p>\n

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.\u00a0 \u00a0\u00a0\u00a0<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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…<\/p>\n","protected":false},"author":1,"featured_media":42692,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-42690","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-u-s-department-of-justice"],"yoast_head":"\nU of Miami to Pay $22 Million to Settle Claims of Fraudulent Billing Practices<\/title>\n<meta name=\"description\" content=\"FLORIDA The University of Miami agreed to pay $22 million to resolve allegations that it violated the False Claims Act by ordering medically unnecessary\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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