Vermont's U.S. Attorney says Brattleboro Memorial Hospital allegedly submitted bills to Medicare and Medicaid without the proper documentation.
BMH paid more than $1.6 million to resolve the allegations that the hospital violated the federal False Claims Act and the Vermont False Claims Act.
U.S. Attorney Christina Nolan says that between January 2012 and September 2014 Brattleboro Memorial knowingly submitted a number of outpatient laboratory claims that lacked proper documentation.
“Health care providers doing business in Vermont need to have systems in place to ensure that the claims they submit for taxpayer reimbursement are valid under the governing rules and regulations,” Nolan said in a press release. “We will hold accountable those who knowingly or recklessly bill the government for health care services without proper documentation to support their claims."
Brattleboro Memorial Hospital spokeswoman Gina Pattison said orders for laboratory tests did not appear to adequately document the diagnosis code included on the billing claim form as required.
Pattison said there have been no allegations that the services billed for were not provided, or that they were unnecessary.
“BMH has made substantial investments within our Patient Financial Services department to address the matter,” said Jonathan Farina, BMH chief compliance officer. “We take issues like this very seriously, and invest considerable time and resources into creating a robust, compliant billing process. Since learning of this billing issue, BMH improved both systems and personnel operations to correct the problem and ensure that we are doing our utmost to comply with the complex requirements for proper billing to all payers.”
Brattleboro Memorial Hospital says beginning in early 2016 it undertook an internal investigation, and voluntarily self-disclosed to the Office of the Inspector General for the U.S. Department of Health and Human Services that the hospital received overpayments as a result of the billing issue.
The settlement was divided between the federal Medicare and Medicaid programs, as well as with Vermont Medicaid, the entities which received the alleged false claims.