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Release No. 06-171

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PRESS RELEASE

FOR IMMEDIATE RELEASE
December 18, 2006
For Information, Contact Public Affairs
Thom Mrozek (213) 894-6947

FLORIDA HOSPITAL PAYS OVER $14 MILLION TO RESOLVE LAWSUIT ALLEGING THAT IT FAILED TO RETURN OVERPAYMENTS FROM GOVERNMENTAL HEALTH INSURANCE PROGRAMS


Los Angeles, CA - Jackson Memorial Hospital in Miami, Florida has paid the federal government $14.25 million to settle allegations that it knowingly failed to disclose and failed to return overpayments made by the federal Medicare and the Florida Medicaid programs, Acting United States Attorney George S. Cardona announced today.

The settlement amount was paid on November 28, and today the government received notice that a federal judge had unsealed allegations against Jackson Memorial that were contained in a "whistleblower" lawsuit.

The settlement resolves allegations made against Jackson Memorial in a lawsuit filed pursuant to the qui tam provisions of the False Claims Act. The whistleblower lawsuit was filed in 1998 by a former employee of Healthcare Financial Advisors (HFA), a consulting firm that assisted hospitals in preparing cost reports that were submitted to the Medicare and Medicaid health insurance programs. The lawsuit alleged that HFA helped its hospital clients seek reimbursement for unallowable costs and helped conceal known overpayments from the government. The lawsuit specifically alleged that HFA helped its clients reopen previously filed cost reports to seek reimbursement for various categories of costs that it had inadvertently failed to claim in its original cost reports, while simultaneously concealing from the Medicare and Medicaid programs overpayments the hospitals knew they had received on account of the cost reports.

Jackson Memorial was accused of knowingly receiving overpayments from Medicare for disproportionate share payments for fiscal years 1987 and 1988 and from Medicaid due to a calculation error in setting Jackson’s per diem rate on its 1989 cost report. The government alleged that Jackson Memorial knew of these overpayments and failed to refund them.

Jackson Memorial paid the settlement without admitting any wrongdoing.

This case was investigated by the Department of Health and Human Services, Office of Inspector General.

The settlement with Jackson Memorial is the latest in a series of settlements with defendants in the qui tam suit. For example, earlier this year, St. Elizabeth Regional Medical Center in Lincoln, Nebraska paid more than $4 million to settle allegations that it had failed to disclose and return overpayments made by the Medicare and the Nebraska Medicaid programs (see: http://www.usdoj.gov/usao/cac/pr2006/149.html). A total of five defendants have settled the HFA whistleblower lawsuit, cumulatively paying approximately $50 million to the government.

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Release No. 06-171

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