Corporate Compliance

MA hospital settles billing violations using the self-disclosure protocol

Compliance Monitor, March 23, 2011

Saints Medical Center in Lowell, MA, will pay $579,000 to settle alleged Medicare billing violations, according to a hospital press release.

Ober|Kaler, a national law firm, released a statement announcing that the settlement is first since the publication of the CMS voluntary self-referral disclosure protocol.

According to Olber|Kaler, CMS reported the settlement amount is substantially less than the calculated overpayment, which is estimated to be anywhere between $785,000 and $14.5 million. The hospital’s press release also suggests that the settlement amount was less than the hospital estimated. The press release says, “The settlement amount is less than the reserve Saints set aside in fiscal year 2009 to address this issue, which was based on management’s estimate of the low end of the range of the potential obligation.”

Saints’ statement did not indicate what violations it had committed. It only stated that “the matter did not involve the quality of patient care or fraud and abuse.” However, the Olber|Kaler statement stated that the settlement resolved violations of the Stark Self-Referral Law.

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