Frank A. Rubino , ESQ.

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Medical center pays $5.3 million in Medicare fraud case

The Beth Israel Deaconess Medical Center will be paying $5.3 million to resolve a Medicare fraud case.

The payment addresses allegations from the United States federal government that the center's actions were in violation of the False Claims Act. Specifically, the government said that Beth Israel had billed Medicare for inpatient stays in cases that should have been classified as observation or outpatient instead. If done intentionally, this would legally qualify as Medicare fraud. The medical center says that there was no such intent.

According to information from the office of U.S. Attorney General Carmen Ortiz, the claims in question had been submitted between June 1, 2004, and March 31, 2008. They were for inpatient admissions with one-day stays, and focused on patients with chest pains, congestive heart failure, and digestive or nutritional disorders. Federal investigators allege that these stays should have been treated as observation services.

The key problem from the government's perspective is that Medicare reimbursement to hospitals is notably higher for inpatient stays. Thus, improperly classified claims cost Medicare substantially more.

Beth Israel Deaconess Medical Center, also known as BIDMC, defends their actions. In a statement, they say that BIDMC admits "no liability whatsoever," and feels that "an inpatient level of service" was in fact appropriate for the patients in question.They feel that they were simply offering quality care to people in need.

The medical center suggests that it simply tripped over Medicare regulations that have changed rapidly in modern times, pointing to other hospitals that have expressed similar views. They expressed that clarification about billing rules is ongoing between hospitals, medical trade associations, the Centers for Medicare and Medicaid Services, and the United States Department of Health and Human Services.

In any area of the country, Medicare fraud legal troubles are serious issues. Finding an attorney who is experienced with Medicare fraud cases will be instrumental. A good one will help you build a quality defense and pursue the best possible outcome.

Source: Boston Business Journal, "Beth Israel to pay $5.3M settlement to resolve Medicare fraud allegations" Julie M. Donnelly, Jul. 29, 2013

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