NEW MILFORD HOSPITAL PAYS $471,933
TO SETTLE ALLEGATIONS UNDER THE FALSE CLAIMS ACT
Third Connecticut hospital to settle similar allegations; total payments exceed $1.4 million
The United States Attorney’s Office for the District of Connecticut today announced that NEW MILFORD HOSPITAL, located at 21 Elm Street in New Milford, has entered into a civil settlement agreement with the Government in which it will pay $471,933 to resolve allegations that the hospital violated the False Claims Act.
The allegations against NEW MILFORD HOSPITAL involve improper billing to Medicare 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 NEW MILFORD HOSPITAL regularly billed the higher-paying female-related Lupron billing code for its male patients who were being treated for prostate cancer. Accordingly, NEW MILFORD HOSPITAL received substantially higher reimbursement from Medicare than it should have received for its Lupron injection services.
In addition, the Government alleges that NEW MILFORD HOSPITAL eventually discovered that it had improperly coded its Lupron injection services and had been overpaid by Medicare. The hospital even conducted an internal audit and quantified the amount it had been overpaid by the Government. However, NEW MILFORD HOSPITAL never reported its improper billing to the Government or made any attempt to pay the money back to the Medicare program.
In 2009 and 2010, Congress specifically amended and strengthened the federal False Claims Act and related statutes to make it clear that health care providers who learn that they have been overpaid by Medicare must notify the Government of the overpayment and return the money to the Medicare program within 60 days. If a provider fails to do so, it is subject to liability under the False Claims Act, which permits the Government to recover triple damages as well as civil penalties.
To resolve its liability under the False Claims Act, NEW MILFORD HOSPITAL will pay $471,933 in order to reimburse the Medicare program for conduct occurring between February 1, 2001 and April 20, 2009.
In entering into the civil settlement agreement, NEW MILFORD HOSPITAL did not admit liability.
NEW MILFORD HOSPITAL is the third Connecticut hospital this year to settle allegations involving improper billing to Medicare for Lupron injections. In April 2011, Masonicare Health Center in Wallingford settled allegations for $447,776, and in August 2011, Saint Francis Hospital and Medical Center in Hartford settled allegations for $516,527.
This matter 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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U.S. ATTORNEY'S OFFICE