States Attorney's Office District of Connecticut
|April 26, 2011||
MASONICARE HEALTH CENTER PAYS $447,776
David B. Fein, United States Attorney for the District of Connecticut, today announced that MASONICARE HEALTH CENTER, a senior-focused inpatient and outpatient health care facility located at 22 Masonic Avenue in Wallingford, has entered into a civil settlement agreement with the Government in which it will pay $447,776 to resolve allegations that the facility violated the False Claims Act.
U.S. Attorney Fein explained that the allegations against MASONICARE HEALTH CENTER (“MASONICARE”) involved improper billing to Medicare and Medicaid for injections of leuprolide acetate (known by the brand name Lupron or Lupron Depot). Lupron is used to treat prostate cancer in men, and endometriosis and fibroids in women. Different dosages of Lupron are used for the treatment of male patients and female patients. The billing code for the female-related dosage of Lupron has a higher reimbursement rate then the billing code for the male-related dosage.
The Government alleges that MASONICARE regularly billed the higher-paying female-related Lupron billing code for its male patients who were being treated for prostate cancer. Accordingly, MASONICARE received substantially higher reimbursement from Medicare and Medicaid than it should have received for its Lupron injection services.
In addition, the Government alleges that, in 2009, MASONICARE realized that it had improperly coded its Lupron injection services and had been overpaid by government health insurance programs. However, MASONICARE never self-disclosed its improper billing to the Government or made any attempt to pay the money back to the Medicare and Medicaid programs.
“Hospitals and other health care providers must be vigilant in correctly billing for the services they render,” stated U.S. Attorney Fein. “As important, if a health care provider learns that it has improperly billed Medicare or Medicaid and has been overpaid, the provider must promptly notify the Government and pay the money back. If a provider fails to do so, it is subject to liability under the False Claims Act, which permits the Government to recover treble damages as well as civil penalties. Health care providers must police themselves or face the potentially severe consequences of liability under the False Claims Act.”
To resolve its liability under the False Claims Act, MASONICARE will pay $447,776, in order to reimburse the Medicare and Medicaid programs for conduct occurring between January 1, 2001 and May 31, 2010.
In entering into the civil settlement agreement, MASONICARE did not admit liability.
This case was investigated by the Office of Inspector General for the Department of Health and Human Services, and was prosecuted by Assistant United States Attorney Richard M. Molot, along with Auditor Kevin A. Saunders.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 785-9270.
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