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Justice News

Department of Justice
U.S. Attorney’s Office
District of Massachusetts

Thursday, April 14, 2016

Boston Medical Center Agrees to Pay $1.1 Million to Resolve Allegations that it Improperly Billed Medicare and Medicaid

BOSTON – United States Attorney Carmen M. Ortiz announced today that Boston Medical Center (BMC) and two of its physician practice organizations have agreed to pay $1.1 million to resolve allegations that BMC improperly billed Medicare and Medicaid. 

“Hospitals have a responsibility to ensure that they are billing federal health care programs appropriately,” said U.S. Attorney Ortiz.  “When taxpayer money is on the line, we have a duty to make certain that it is spent appropriately.  We commend BMC for taking steps to address its billing issues both before and after the government’s investigation arose.”

“Taxpayers fund Medicare and Medicaid services to care for medically vulnerable populations,” said Special Agent in Charge Phillip M. Coyne, Office of Inspector General for the U.S. Department of Health and Human Services.  “With our law enforcement partners we will continually work to protect people relying on these government health programs.”

Specifically, the settlement resolves allegations that (1) BMC billed Medicare for more units of Rituxan, an expensive cancer drug, than BMC actually infused in its patients; (2) BMC billed Medicare and Medicaid for services at its pre-surgical treatment center even though the global fee for the subsequent surgeries covered those same treatments; and (3) BMC submitted claims to Medicare for outpatient podiatry services where the clinical documentation did not support the reasonableness and necessity of the services.

After learning of the government investigation, BMC informed the United States that it already had repaid certain improperly used funds, had undertaken an audit of the Rituxan issue, and was about to commence an audit of the pre-surgical treatment billing issue.  BMC subsequently worked cooperatively with the U.S. Department of Health and Human Services, Office of the Inspector General, and the Department of Justice to address the remaining matters at issue.

The settlement resolves allegations filed by BMC’s former Chief Compliance Officer, Kathleen Heffernan.  The False Claims Act permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery. 

This matter was investigated by the U.S. Department of Health and Human Services, Office of the Inspector General, and the Federal Bureau of Investigation.  It was handled by Assistant U.S. Attorney Gregg Shapiro of Ortiz’s Civil Division.

Updated April 14, 2016