Corporate Compliance

NJ hospital to pay United States $6.35 million for alleged Medicare fraud

Compliance Monitor, March 24, 2010

A New Jersey hospital will pay the United States $6.35 million for allegedly inflating charges to receive larger reimbursements from the Medicare program, according to a Department of Justice (DOJ) press release.

Robert Wood Johnson University Hospital Hamilton (RWJ) allegedly took advantage of Medicare’s outlier payment system, which provides additional reimbursement for cases where the cost of patient care is exceptionally high. According to the DOJ, RWJ allegedly inflated charges to obtain unnecessary outlier payments for cases that were not unusually costly.

Two lawsuits were filed against RWJ under the qui tam provisions of the False Claims Act. The two whistleblowers will receive approximately $1.1 million of the total recovery.

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