BOSTON â€“ United States Attorney Carmen M. Ortiz announced today that Boston Medical Center (BMC) and two of its physician practice organizations have agreed to pay $1.1 million to resolve allegations that BMC improperly billed Medicare and Medicaid.
â€œHospitals have a responsibility to ensure that they are billing federal health care programs appropriately,â€ said U.S. Attorney Ortiz.Â â€œWhen taxpayer money is on the line, we have a duty to make certain that it is spent appropriately.Â We commend BMC for taking steps to address its billing issues both before and after the governmentâ€™s investigation arose.â€
â€œTaxpayers fund Medicare and Medicaid services to care for medically vulnerable populations,â€ said Special Agent in Charge Phillip M. Coyne, Office of Inspector General for the U.S. Department of Health and Human Services. Â â€œWith our law enforcement partners we will continually work to protect people relying on these government health programs.â€
Specifically, the settlement resolves allegations that (1) BMC billed Medicare for more units of Rituxan, an expensive cancer drug, than BMC actually infused in its patients; (2) BMC billed Medicare and Medicaid for services at its pre-surgical treatment center even though the global fee for the subsequent surgeries covered those same treatments; and (3) BMC submitted claims to Medicare for outpatient podiatry services where the clinical documentation did not support the reasonableness and necessity of the services.
After learning of the government investigation, BMC informed the United States that it already had repaid certain improperly used funds, had undertaken an audit of the Rituxan issue, and was about to commence an audit of the pre-surgical treatment billing issue.Â BMC subsequently worked cooperatively with the U.S. Department of Health and Human Services, Office of the Inspector General, and the Department of Justice to address the remaining matters at issue.
The settlement resolves allegations filed by BMCâ€™s former Chief Compliance Officer, Kathleen Heffernan.Â The False Claims Act permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.Â
This matter was investigated by the U.S. Department of Health and Human Services, Office of the Inspector General, and the Federal Bureau of Investigation.Â It was handled by Assistant U.S. Attorney Gregg Shapiro of Ortizâ€™s Civil Division.