On July 1, 2013, the United States Attorney for the Western District of Kentucky and the Office of Inspector General of the U.S. Department of Health and Human Services announced that University Medical Center (University of Louisville Hospital) has voluntarily entered into a settlement agreement with the United States to pay $2,833,408.60 to settle allegations that it submitted or caused to be submitted false claims for payment to the Medicare program in violation of the Federal False Claims Act. University Medical Center, Inc. (“UMC”) is the 501(c) (3) organization which leases, operates and manages the University of Louisville Hospital and the James Graham Brown Cancer Center. UMC bills federal government health care programs, including Medicare, the TRICARE Program and Medicaid, for services it performs.
The False Claims Allegations
The U.S. government alleged that University of Louisville Hospital’s FirstCare, a separate fast track unit within its emergency department that provides non-urgent care, was staffed by UMC-employed physician assistants (PAs) and nurse practitioners (NPs) under the direction of the Department of Emergency Medicine physicians (which operates as University Emergency Medicine Associates). From January 1, 2006 through December 31, 2010, the salaries and benefits paid to FirstCare PAs and NPs were claimed on UMC cost reports filed with Medicare. At the same time, University Emergency Medicine Associates physicians generally treated the FirstCare PAs and NPs as their own employees including, to various degrees, billing and collecting from Medicare for their professional services, thereby resulting in double-billing to, and payment by, Medicare for the same services.
University Medical Center self-reported in April 2011 that it may have violated federal law concerning the relationships it had with certain health care providers. UMC did not admit liability in reaching the settlement with the U.S. government.
In announcing the settlement, the U.S. Attorney for the Western District of Kentucky stated, “Pursuing health care fraud is a priority of my Office, the Department of Justice, and the Department of Health and Human Services. Those that do not follow the rules designed to safeguard our nation’s health care resources will be held to account.”
We are amazed and alarmed that hospital systems throughout the United States continue to bill Medicare and other federal health care programs for services and tangible items when they knew or should have known that the charges were inappropriate. It is noteworthy that UMC self-reported the alleged false claims payments before the U.S. government discovered the discrepancies (which raises the issues of why the federal government did not discover the improper charges and payments before UMC contacted it, and what other inappropriate payments have been made to hospitals and other health care and medical equipment providers throughout the United States that have not – and may not – be discovered) but just because UMC “did the right thing” after-the-fact does not excuse that the improper claims were billed and paid over a period of years that unjustly enriched UMC.
If you have been injured or suffered other harms as a result of medical malpractice in the Unite States, you should promptly contact a local medical malpractice attorney in your state who may agree to investigate your medical malpractice claim for you and file a medical malpractice lawsuit on your behalf, if appropriate.
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