DOJ orders repayment of improper Medicare reimbursements

The Office of Inspector General’s reports on Medicare fraud are in—and it’s time to send out the bills. The joint investigation team from Department of Health & Human Services and the Department of Justice—nicknamed the Medicare Fraud Squad—has issued several reclamation notices this week, encompassing millions in improperly billed services.

Dallas-based Baylor University Medical Center, Baylor Health System and HealthTexas Provider Network yesterday agreed to pay a $907,000 settlement related to claims of false billing to Medicare and two other federal health plans between 2006 and 2010, according to the U.S. Attorney General’s office.

Most of the claims involved radiation oncology services, including specialized treatments like targeted radiation therapy. The OIG claims that Baylor upcoded its bills and failed to document physician involvement adequately, the Dallas Morning News reported today.

Federal authorities were alerted to the situation by two Baylor radiology department employees, whose 80-page suit spurred the investigation.

Another whistle-blower suit led to Florida-based Morton Plant Mease Health Care’s $10 million settlement last week over improperly billed cardiac procedures billed between 2006 and 2008, according to the Department of Justice. The primary components in the case were cardiac services billed as inpatient that should have been performed under outpatient or observational status.

Also last week, an OIG report assessed the University of Iowa Hospitals and Clinics for $826,000 in Medicare overbilling. The hospital system is contesting the amount, saying $555,000 in billing is related to an incorrect code for a cancer drug. The other $271,000 would be given back to Medicare, the hospital told the associated press.

The flurry of investigations stems from the False Claims Act, which allows the Justice Department to seek restitution on those who submit fraudulent bills to federal health care programs. This initiative is one of many efforts resulting from the partnership between Health & Human Services and the Justice Department, who joined forces in 2009 to combat Medicare and Medicaid billing fraud. Approximately $10.1 billion has been recovered since the crackdown began.

Topics: Executive Leadership , Medicare/Medicaid , Regulatory Compliance