LAWFUEL – Law News, Law Jobs – R. Alexander Acosta, United States Attorney for the Southern District of Florida, announced today a civil settlement between the United States of America and the University of Miami. The settlement relates to medical services rendered at Jackson Memorial Hospital by physicians working at the University of Miami’s teaching hospital. The settlement provides for a payment to the United States in the amount of $2,270,162.
This civil settlement arose from an investigation and audit conducted by the Department of Health and Human Services of claims submitted by the University of Miami to the Medicare Part B Program for services provided to hospital inpatients rendered between June 1, 1995 and May 31, 1996. One hundred patient files were selected and all billed services for those patients were included in the audit. The results were then projected over all inpatient services billed to Medicare Part B during that time period. Additional claims were also reviewed related to services performed in 1997 through 1999.
The United States contends that the University of Miami submitted claims for services which it had represented had been personally and identifiably provided by University of Miami faculty when the University of Miami did not possess sufficient documentary evidence to support the claims, for claims which were improperly coded at a level of service that was not supported by the documentation of those services, and for services provided by the University of Miami faculty for which the University of Miami did not have any, or sufficient, documentation to satisfy the requirements of Medicare.
The United States also contends that during the period from June 1, 1995 through December 31, 1999, the University of Miami submitted claims for critical care services in situations where patients were not critically ill, where critical care services were not rendered, or where critical care services were insufficiently documented.
Lastly, the United States contends that during the period from June 1, 1995 through December 31, 1999, U of M submitted claims for items which were billed in connection with neurosurgeries in circumstances where the services should not have been separately billed.
Mr. Acosta commended the investigative efforts of the Office of Audit Services of the Department of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Mark Lavine.
A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls .