Beth Israel Deaconess Medical Center to Pay $5.3 Million to Resolve
Improper Medicare Claims
Seattle Whistleblower and False Claims Act Qui Tim Attorneys announce that Beth Israel Deaconess Medical Center (BIDMC), a teaching hospital located in Boston, has agreed to pay the United States $5.315 million to settle allegations that it violated the False Claims Act by billing Medicare for inpatient admissions that should have been billed as lower reimbursed outpatient or observation services. The improper claims were submitted from June 1, 2004, through March 31, 2008.
The False Claims Act case settlement resolves government allegations that BIDMC inappropriately submitted claims to Medicare for one-day stay inpatient admissions for patients with congestive heart failure, chest pain, and certain digestive and nutritional disorders. These claims should have been billed as observation services as the patients were briefly admitted for the limited purpose of observation and discharged the next day. In addition, the settlement resolves allegations that BIDMC submitted claims to Medicare for less-than-one day (zero day) stays that should have been billed as outpatient or observation services. Medicare reimburses hospitals, like BIDMC, at significantly higher amounts for inpatient admissions compared to outpatient or observation services. BIDMC has not admitted liability or wrongdoing in connection with the settlement.
“Today’s settlement furthers two critical purposes: ensuring that precious federal health care dollars are spent appropriately and in accordance with the law, and emphasizing that patient needs, not the bottom line, must be the basis for treatment decisions,” said U.S. Attorney Ortiz.
"When hospitals unnecessarily admit Medicare patients for short inpatient stays when the appropriate treatment would be outpatient or observation care, they improperly boost hospital profits at significant expense to taxpayers and patients," said HHS-OIG's Waddell. "We are committed to uprooting such schemes to eliminate waste in federal health care programs."
The claims resolved by this False Claims Act settlement are allegations only, and there has been no determination of liability.
Source: Dept. of Justice
The False Claims Act case settlement resolves government allegations that BIDMC inappropriately submitted claims to Medicare for one-day stay inpatient admissions for patients with congestive heart failure, chest pain, and certain digestive and nutritional disorders. These claims should have been billed as observation services as the patients were briefly admitted for the limited purpose of observation and discharged the next day. In addition, the settlement resolves allegations that BIDMC submitted claims to Medicare for less-than-one day (zero day) stays that should have been billed as outpatient or observation services. Medicare reimburses hospitals, like BIDMC, at significantly higher amounts for inpatient admissions compared to outpatient or observation services. BIDMC has not admitted liability or wrongdoing in connection with the settlement.
“Today’s settlement furthers two critical purposes: ensuring that precious federal health care dollars are spent appropriately and in accordance with the law, and emphasizing that patient needs, not the bottom line, must be the basis for treatment decisions,” said U.S. Attorney Ortiz.
"When hospitals unnecessarily admit Medicare patients for short inpatient stays when the appropriate treatment would be outpatient or observation care, they improperly boost hospital profits at significant expense to taxpayers and patients," said HHS-OIG's Waddell. "We are committed to uprooting such schemes to eliminate waste in federal health care programs."
The claims resolved by this False Claims Act settlement are allegations only, and there has been no determination of liability.
Source: Dept. of Justice