Recently, Yale New Haven Health Services Corp. and Northeast Medical Group, Inc., agreed to pay more than half a million dollars to settle federal and state False Claims Act allegations. According to a qui tam lawsuit brought by a former Northeast Medical employee, Yale (a hospital) and Northeast Medical (a hospitalist group) submitted claims for evaluation and management services that did not satisfy the requirements to be billed under hospitalist physicians but should have instead been billed under advanced practice registered nurses and physician assistants.
Under the settlement, Yale New Haven and Northeast Medical will pay $560,718.48 to resolve the allegations that from July 2014 to June 2020, they submitted the improper claims as outlined above to the federal Medicare and Connecticut Medicaid programs. In the claims, Yale New Haven and Northeast Medical billed services as being performed by hospitalists and the mid-level providers instead of properly billing as just being performed by the mid-level providers. Services that are provided just by mid-level providers are reimbursed at a lower rate.
As a result of the improper billings, the United States Attorney’s Office for the District of Connecticut states that Yale and Northeast medical received between 10 and 15% more in Medicare and Medicaid reimbursements for the allegedly falsely billed hospitalist physician services.
For her role in the case, the relator will receive $106,536.51 (19% of the total settlement amount) as her share of the recovery. Medicaid’s share of the settlement is $110,042. The case resolved by this settlement was captioned U.S. ex rel. Cadariu v. Northeast Medical Group et al. (Docket No. 19-cv-904).
“Northeast Medical Group and YNHH allegedly submitted hundreds of thousands of dollars of claims to government healthcare programs at rates they knew or should have known they were not owed yet failed to correct their inflated billing practices. I thank the whistleblower for stepping forward to report these dubious claims and to protect our public healthcare dollars,” said Connecticut Attorney General William Tong.