On May 9, the U.S. Attorney’s Office in the District of Connecticut announced that Yale New Haven Health Services Corp. (Yale) and Northeast Medical Group, Inc. (Northeast Medical) agreed to pay $560K to settle allegations that they violated the federal and state False Claims Acts (FCA). The government alleges that Yale and Northeast Medical billed for services performed by physicians when, in fact, the services should have been billed by mid-level providers at a lower reimbursement rate.
The case was instigated by a whistleblower who filed a civil suit under the qui tam provision of the FCA. Qui tam claims enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery. The unidentified whistleblower in the case will receive $106,536.51.
According to the government’s allegations “between July 2014 and June 2020, Yale and Northeast Medical violated the federal and state False Claims Acts by submitting false claims to Medicare and Medicaid for evaluation and management services billed by Northeast Medical hospitalist physicians to Bridgeport Hospital patients that did not satisfy certain billing requirements and, instead, should have been billed by mid-level providers. As a result, Yale and Northeast Medical improperly received 10 to 15 percent higher in Medicare and Medicaid reimbursements for the allegedly falsely billed hospitalist physician services. To resolve their liability, Yale and Northeast Medical have paid $560,718.48.”
On June 1, the Supreme Court issued an unanimous ruling in a landmark False Claims Act case which whistleblower advocates say will help ensure the future efficacy of the law in fighting fraud.