Corporate Compliance

CT hospital settles suit that claimed it over-billed Medicare

Compliance Monitor, July 4, 2007

John Dempsey Hospital of Farmington, CT will pay more than $475,000 to the federal government to resolve allegations that it violated the False Claims Act.

Some of the allegations against the hospital involve charges to Medicare for infusion therapy and chemotherapy administration, as well as charges for the chemotherapy drug Herceptin.

During the time period at issue, Medicare paid for one unit of infusion therapy or chemotherapy administration per patient visit, regardless of the number of hours the patient received treatment. However, on many occasions, the hospital billed Medicare for multiple units of these services, based the number of hours the patient was treated. Thus, instead of billing for one unit per patient visit, the hospital often billed between two and seven units per visit.

Relevant regulations also require providers to bill Herceptin to Medicare at 10 mg per unit. For example, a 130 mg dose should be billed as 13 units. However, for certain patients, the hospital billed Medicare far in excess of the 10 mg per unit amount required by the regulations.

Click here to read the Department of Justice's press release.

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