Greater Metropolitan Orthopaedics Institute Agrees to Pay $2.5 Million to Resolve False Claims Allegations
BALTIMORE, MD – Greater Metropolitan Orthopaedics Institute (“GMO”) in Clinton, Maryland has agreed to pay $2.5 million to settle allegations under the False Claims Act that it submitted false claims to Medicare, TRICARE Management Administration and the Federal Employees Health Benefits Program by upcoding services rendered to higher levels to increase its reimbursement and by billing for services not rendered. The settlement agreement was signed yesterday.
The settlement was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; Special Agent in Charge Robert Craig of the Defense Criminal Investigative Service - Mid-Atlantic Field Office; and Special Agent in Charge Drew Grimm, Office of Personnel Management, Office of Inspector General
United States Attorney for the District of Maryland Rod J. Rosenstein said, “This case demonstrates our resolve to combat health care fraud.”
The allegations resolved in the settlement include the submission of claims for office visits that either never took place or were not documented in the patients’ medical records, billing new or existing patient visits as consults, and submitting duplicate claims for review and interpretation of X-rays. The settlement agreement resolves issues relating to claims submitted between January 1, 2004 and December 31, 2008. GMO has also entered into a Corporate Integrity Agreement with the Department of Health and Human Services, Office of Counsel to the Inspector General as part of the resolution of the investigation.
Enacted during the Civil War, the False Claims Act is the government’s primary civil tool to combat fraud and abuse in federal programs and procurement. The Act allows the government to recover triple the amount of its actual damages, plus a civil penalty of $5,500 to $11,000 for each false claim.
The settlement announced today was the result of an investigation by the U.S. Attorney’s Office for the District of Maryland with assistance from the U.S. Department of Health and Human Services, Office of Inspector General; the Department of Defense Criminal Investigative Services; and the Office of Personnel Management, Office of Inspector General. The investigation was handled by Assistant United States Attorney Jamie M. Bennett.