Beth Israel Deaconess Medical Center will pay the federal government over $5 million after allegedly making false Medicare claims over a four-year span, U.S. Attorney Carmen M. Ortiz announced today.
The teaching hospital 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 government accused Beth Israel of inappropriately submitting claims to Medicare for one-day stay inpatient admissions for patients with congestive heart failure, chest pain, and certain digestive and nutritional disorders. Ortiz said 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.
The settlement also resolves allegations that Beth Israel submitted claims to Medicare for less-than-one day stays that should have been billed as outpatient or observation services. Medicare reimburses hospitals, like Beth Israel, at significantly higher amounts for inpatient admissions compared to outpatient or observation services, according to Ortize.
The hospital 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,” Ortiz said.