May 10, 2021

The University of Miami, which operates multiple hospitals and other healthcare facilities, will pay $22 million to resolve claims arising from allegedly fraudulent billing submitted to federal healthcare programs for laboratory services.  The university was alleged to have billed certain laboratory tests as having been provided at hospital facilities instead of at physician offices, without satisfying the requirements for that more costly hospital facility billing, including notice requirements.  In addition, the university was alleged to have performed and billed for a pre-set panel of tests for all kidney transplant patients, although not all included tests were medically necessary.  Finally, the university and Jackson Memorial Hospital, which jointly operated the kidney transplant program, were alleged to have violated related party restrictions by billing for pre-transplant laboratory tests ordered by JMH from the university, and JMH will pay an additional $1.1 million to settle these allegations.  The settlement resolves claims made in three separate qui tam lawsuits; the whistleblower’s share has not yet been determined.  DOJ; USAO SD FL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,