The United States Attorney’s Office for the District of Vermont announced today that Brattleboro Memorial Hospital, Inc. (BMH) has paid $1,655,000 to the United States and the State of Vermont to resolve civil claims that BMH violated the federal False Claims Act, 31 U.S.C. § 3729, and the Vermont False Claims Act, 32 V.S.A. § 630, by knowingly presenting, or causing to be presented, false claims for payment to Medicare and Medicaid. The money will be divided between the federal Medicare, federal Medicaid, and Vermont Medicaid programs to which BMH submitted the alleged false claims.
BMH is a not-for-profit community hospital located in southeastern Vermont whose services include out-patient laboratory work. On February 5, 2016, relator Amy Beth Main filed a complaint against BMH under the qui tam provisions of the federal False Claims Act. The United States Attorney’s Office for the District of Vermont intervened in that action on February 22, 2018 after having investigated and resolved the matter. The government contends that from approximately January 2012 through September 2014 BMH knowingly submitted or caused to be submitted a number of outpatient laboratory claims lacking documentation necessary to support reimbursement by Medicare and Medicaid.
“Health care providers doing business in Vermont need to have systems in place to ensure that the claims they submit for taxpayer reimbursement are valid under the governing rules and regulations,” said United States Attorney Christina E. Nolan. “We will hold accountable those who knowingly or recklessly bill the government for health care services without proper documentation to support their claims.”
The settlement announced today resolves the foregoing allegations without the need for further litigation. Pursuant to the settlement agreement, the settlement and payment are neither an admission of liability by BMH, nor a concession by the United States or State of Vermont that their claims are not well founded.
This matter was investigated by the United States Attorney’s Office for the District of Vermont, with assistance from the Office of the Inspector General of the Department of Health and Human Services, and by the Medicaid Fraud and Residential Abuse Unit of the Vermont Attorney General’s Office. Assistant United States Attorney Owen C.J. Foster handled the matter on behalf of the United States. Vermont Assistant Attorney General Steven J. Monde of the Medicaid Fraud and Residential Abuse Unit represented the State of Vermont. Norman Watts represented relator Amy Beth Main. Kevin Henry and Anne Cramer of the law firm Primmer Piper Eggelston & Cramer, PC represented BMH.