On July 29th, the US Attorney’s Office in Boston and the Department of Health and Human Services announced a settlement with Beth Israel Deaconess Medical Center that resolves False Claims Act allegations of improper Medicare billing. Although the billing in question took place between June 2004 and March 2008, the Boston Globe has reported that the government subpoenaed records from Beth Israel Deaconess in 2010 in connection with the case.
According to the US Attorney’s Office release, the government’s False Claims Act case accused the hospital of inappropriately submitting claims for reimbursement to Medicare for one-day stay inpatient admissions for patients with congestive heart failure, chest pain, and certain digestive and nutritional disorders. The government contended that such claims should not have been for inpatient services, but for observation services, as they were admitted only for the purpose of observation and discharged the next day. According to the government, additional claims to Medicare for inpatient services for “zero day” (less than one day) admissions were also inappropriate.
Beth Israel Deaconess did not admit to any wrongdoing or liability as part of the settlement; according to the Globe, Beth Israel Deaconess general counsel Jamie Katz said in a written statement that the billing “involved an extremely technical issue.”
The federal False Claims Act imposes liability for the submission of false claims for payment to the government. In addition, the statute also imposes liability for retaining overpayments received by the government. Since passage of the Affordable Care Act, entitles that participate in federal health insurance programs have 60 days upon discovery of an overpayment to return the difference to the government. For conduct to be actionable under the False Claims Act, it must have cheated the government knowingly, or acted in reckless disregard or deliberate ignorance of a claim or statement’s falsity. Under the qui tam provision of the False Claims Act, whistleblowers are entitled to sue on the government’s behalf and to keep between 15% and 30% of any recovery.