California hospital pays $ 11.4 million, settles whistleblower claims

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San Mateo, Calif., Medical Center will pay $ 11.4 million to resolve allegations of incorrectly submitting hospital claims, the US Department of Justice said on August 6.

Prosecutors allege that the San Mateo Medical Center violated false claims law by submitting claims to Medicare for uncovered inpatient admissions. In particular, prosecutors say that from January 1, 2013 to February 28, 2017, the medical center admitted patients who did not need hospital care, including those who were admitted for reasons other than their medical condition. The medical center allegedly billed Medicare for these admissions despite knowing Medicare was not reimbursing these cases.

“Billing for uncovered hospital stays results in misuse of federal dollars,” said Acting Deputy Attorney General Brian Boynton of the Civil Division of the Department of Justice. “Today’s regulation demonstrates our continued commitment to ensure Medicare only pays for services eligible for reimbursement.”

As part of the settlement, the medical center also entered into a five-year corporate integrity agreement with HHS, requiring San Mateo Medical Center to have someone review inpatient admissions annually. billed to Medicare.

The settlement resolves claims filed by whistleblower Felix Levy, a former employee of the medical center.

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