by Deb Cupples | The Justice Department States:
"The government alleged that, between January 2001 and August 2003, Methodist improperly inflated charges for inpatient and outpatient care to make its costs for providing such care appear greater than they actually were, and thereby obtain outlier payments from Medicare that it was not entitled to receive."
While the settlement is about $9 million, the Justice Department doesn't actually state by how much hospital staff had allegedly over-billed us taxpayers. It is possible that the alleged over billing amounted to far more than $9 million.
Certainly, Methodist Hospital isn't the first health care company to allegedly rob us taxpayers by submitting false claims.
Just days ago, a couple doctors at a Miami HIV clinic pleaded guilty to crimes related to a $10 million fraud scheme against Medicare. Last year, I did a post containing more than a dozen examples of healthcare companies that had settled Justice Department fraud suits for millions of dollars (e.g., hospitals, labs, drug companies, pharmacies...).
The U.S. False Claims Act makes it illegal for private contractors to present false claims to the government (i.e., to rip off us taxpayers). Companies found guilty of violations can be barred from getting government contracts -- which may be why so many companies settle the FCA lawsuits without admitting or denying guilt.
Yes, many companies, both health-care related and not, have spent millions settling Justice Department FCA lawsuits and later got big federal contracts.
Update: a commenter pointed out that this particular case may not involve the False Claims Act. Hat tip to the commenter.
Other Buck Naked Politics Posts:
* Insurance Companies Get Away with Over-billing Medicare
* Contractor Fraud: Driving up Health Care Costs
* Defense Dept. Rewarding Bad Contractor Performance?
I am an auditor in Health care- Medicare rules are different than false claims acts. If the company self reported which judging the dollar amount is the case than it usually twice the lost otherwise there are hefty fines per claim.
Posted by: Eugene Boado | March 30, 2009 at 06:11 PM
Hi Eugene,
The False Claims Act is pretty broad: I've seen some Medicare fraud cases involve the FCA or some FCA cases involve Medicare Fraud.
That said, I think YOU'RE RIGHT about this particular case. I went back to the DoJ press release, and it does NOT mention the FCA.
I've updated the blog post accordingly. Thanks for pointing it out.
Posted by: Deb | April 01, 2009 at 01:52 AM