Health Information Management

News: Three New Jersey hospitals make headlines for allegedly defrauding Medicare

CDI Strategies, February 7, 2008

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According to a January 24 report published on the U.S. Department of Justice (DOJ) Web site, the United States has intervened against three New Jersey hospitals involved in two whistleblower lawsuits alleging that the hospitals defrauded Medicare. The three hospitals are Robert Wood Johnson University Hospital at Hamilton, Barnert Hospital in Paterson, and Bayonne Hospital.

The two whistleblower lawsuits allege that the three hospitals fraudulently inflated their charges to Medicare patients to obtain enhanced reimbursement from Medicare, according to the DOJ report.

In addition to its standard payment system, Medicare provides supplemental reimbursement, called "outlier payments," to hospitals and other healthcare providers in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payment system to ensure that hospitals possess the incentive to treat inpatients whose care requires unusually high costs.



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