Hospital Admits to Having Increased Charges Without Directly Taking Costs into Account and Generating More Medicare Reimbursements than it Would Have Otherwise Received
Preet Bharara, the United States Attorney for the Southern District of New York, announced today that the United States has filed and simultaneously settled a civil health care fraud lawsuit against LENOX HILL HOSPITAL (“LENOX HILL”).
The Government’s Complaint seeks damages and civil penalties under the False Claims Act from LENOX HILL for fraudulently inflating its charges for services provided to Medicare patients to obtain larger supplemental reimbursement, known as “outlier payments,” that Medicare pays to hospitals and other health care providers in cases where the cost of care is unusually high.
In the settlement, LENOX HILL admitted, acknowledged, and accepted responsibility for having increased its charges based on revenue models that did not directly take into account the costs of the services provided, and as a result obtaining Medicare outlier payments it would not otherwise have received.
LENOX HILL also agreed to pay $11,750,000 to resolve the Government’s claims for damages and civil penalties under the False Claims Act. The settlement was approved today by United States District Court Judge Naomi Reice Buchwald.