United States and Dartmouth Hitchcock Settle Alleged Billing Fraud Matter
Burlington, VT – The Office of the United States Attorney for the District of Vermont stated today that it has settled a False Claims Act matter involving billing with Dartmouth Hitchcock Clinic ("Dartmouth Hitchcock"). The parties settled allegations of improper billing to various federal health programs, such as Medicare and Medicaid. The States of Vermont and New Hampshire also participated in the settlement. Under the terms of the agreement, Dartmouth Hitchcock agreed to pay a total sum of $551,191.00. Of that amount, the State of Vermont received $21,789.50; and the State of New Hampshire received $8,242.50. Federal health programs recovered over $500,000.00.
The investigation arose in 2009 following Dartmouth Hitchcock's self disclosure of improper billing practices by one physician in the Neurology Department at Dartmouth Hitchcock. These improper billing practices concerned Evaluation and Management (E&M) services that were not supported by appropriate medical record documentation and/or were coded incorrectly. The Government's investigation revealed that other improper billing practices related to E&M services existed for at least five other physicians within the Neurology Department at Dartmouth Hitchcock.
The United States contends that the regulations and guidelines related to billing and coding are direct and clear and that the failure to abide by these requirements constituted, at a minimum, reckless disregard under the False Claims Act. The billings at issue spanned the years 2004 through June 2008. Dartmouth Hitchcock denies any liability. The parties have settled to avoid the burden, expense and risks inherent in litigation and a trial.
The United States acknowledges Dartmouth Hitchcock's cooperation and corporate citizenship throughout the investigation, including the burden of engaging in significant audits at the Government's request and undertaking corrective actions. The Government also notes that the allegations did not implicate the quality of care provided by Dartmouth Hitchcock.
This matter was investigated by the United States Attorney's Office and the U.S. Health and Human Services Office of the Inspector General.
The United States was represented during the investigation by Assistant United States Attorney Nikolas P. Kerest. The State of Vermont was represented by Assistant Attorney General Edward Baker. The State of New Hampshire was represented by Assistant Attorney General Karin Eckel. Dartmouth Hitchcock was represented by Mark R. Fitzgerald of Powers Pyles Sutter & Verville PC in Washington, D.C. and Michael J. Connolly of Hinckley Allen Snyder, LLP in Concord, New Hampshire.