Post by miamianne67 on Nov 7, 2020 1:17:06 GMT
Miami Herald LogoUM agrees to pay millions to settle Medicare fraud allegations raised by whistle-blower | Miami Herald
BY JAY WEAVER AND DANIEL CHANG
NOVEMBER 04, 2020 07:00 AM, UPDATED 8 HOURS 25 MINUTES AGO
UHealth provides more than 90 percent of the physicians at Jackson, which is the training hospital for UM’s Miller School of Medicine. For a time, the relationship grew strained, partly because UM purchased the former Cedars Medical Center across the street.
UHealth provides more than 90 percent of the physicians at Jackson, which is the training hospital for UM’s Miller School of Medicine. For a time, the relationship grew strained, partly because UM purchased the former Cedars Medical Center across the street. CARL JUSTE MIAMI HERALD STAFF
A federal lawsuit unsealed Monday after seven years of secrecy has revealed fraud allegations by a former University of Miami senior executive that the school’s healthcare system billed millions of dollars in unnecessary lab tests to Medicare and stuck patients with hidden charges for clinic visits.
The U.S. Justice Department began investigating the allegations after they were first raised by the former chief operating officer of the UM Miller School of Medicine, Jonathan “Jack” Lord, who filed a whistle-blower lawsuit in 2013.
Lord accused the university of filing false claims with Medicare for unnecessary organ transplant tests and overcharging patients for clinic visits during a period when UM was struggling with massive debt after undertaking an ambitious transformation of the medical school into a sprawling academic healthcare system under past president Donna Shalala. She is now a Miami congresswoman who suffered a surprising upset in her race for reelection late Tuesday.
Court records show UM and the Justice Department, which joined Lord’s lawsuit, have reached an “agreement in principle.” The proposed settlement is likely to cost the private university $22 million to resolve the so-called False Claims Act case.
UM said in a prepared statement, “We hope to finalize the settlement in the coming weeks,” and added that the university has not admitted any wrongdoing.
Lord, who was forced out by Shalala seven years ago, is expected to receive about $4 million as a reward for initiating the suit against his former employer.
Significantly, the imminent settlement means that the Justice Department has adopted a handful of key allegations in Lord’s complaint against Coral Gables-based UM, which operates a medical school out of the public Jackson Memorial Hospital in Miami and a sprawling UHealth network across four counties. The lawsuit was unsealed Monday by order of U.S. District Judge Cecilia Altonaga.
The U.S. Attorney’s Office in Miami and Justice Department, which prosecuted Lord’s whistle-blower case, declined to comment about the planned settlement.
Lord’s suit claims that illegal practices were “not only well known to UM at the highest corporate level, but were encouraged” — accusations that triggered “parallel criminal and civil investigations” into UM’s allegedly fraudulent billing of Medicare for organ transplant surgeries and other patient services.
However, the criminal probe led by the FBI and the Department of Health and Human Services concluded without any charges against the university or any employee, according to several sources familiar with the investigation.
Under the proposed settlement, UM has agreed to pay the federal government civil damages for overcharging the taxpayer-funded Medicare program for pathology lab services at Jackson Memorial. Lord’s whistle-blower suit claims that UM’s labs improperly billed the Medicare program for thousands of unnecessary pathology tests involving kidney and other organ transplant surgeries.
The university has also agreed to pay the Justice Department for imposing a surcharge on patients at UM-affiliated medical offices without notifying them of the actual cost for each visit. The patients were charged an extra hospital-based fee — sometimes in the hundreds of dollars — for visits to doctors’ offices that were not located at UM’s hospital campus in Miami. The surcharge was incurred by the Medicare program, which serves the elderly and indigent.
UM’s planned settlement with the federal government will resolve potentially hundreds of millions of dollars in disputed false claims over lab tests and patient surcharges spanning nearly a decade.
The agreement will allow the Medicare program to keep most of UM’s settlement payment. Lord will receive about 20% of the payment under a Justice Department formula for False Claims Act cases.
Here are important steps patients can take to prevent fraudulent or mistaken billing and other problems, according to the Centers for Medicare and Medicaid Services. Fraud costs patients in the long run. BY CENTERS FOR MEDICARE AND MEDICAID SERVICES
The big losers are UM Health System’s patients, especially those who paid out of pocket or through private insurers for the hidden hospital-based fees at doctors’ offices and clinics affiliated with the university. The patients won’t receive any compensation because a planned class-action case for the fee surcharges could not be filed within the statute of limitations while the whistle-blower suit was still under seal in Miami federal court.
UM’s lawyer downplayed the false billing allegations and stressed instead that patients received quality care from the UHealth System.
“These allegations have absolutely nothing to do with patient care but mostly derive from disagreements over regulatory interpretation,” UM’s attorney, Dan Gelber, told the Miami Herald. “The government has never claimed the University failed to provide excellent care to its patients or that it billed for services it did not provide. All other allegations have been outright abandoned by the government.”
Until now, neither the university nor UHealth had ever been the target of a Justice Department probe alleging fraudulent billing, which is the centerpiece of Lord’s whistle-blower case.
In 2013, the university was ordered to refund $3.7 million to Medicare after a federal audit of its billing practices found the hospital overcharged the program in 2009 and 2010, according to a report by the U.S. Department of Health and Human Services Office of Inspector General.
Lord’s whistle-blower suit, filed under seal in July 2013 by his attorney, Jeffrey Sloman, names only the university as a defendant. Lord’s attorney, with the Miami law firm Stumphauzer Foslid Sloman, said he could not comment on the case until there is a settlement.
Lord, now 66, was the No. 2 executive at UM’s Miller School of Medicine before being forced out in January 2013. But he wasn’t the only UM employee who alleged wrongdoing by the university.
Separately from Lord, two senior UM medical school physicians, Joshua Yelen and Philip Chen, in the pathology department, filed similar whistle-blower lawsuits — as did a former finance director for Jackson Memorial, Mitchell Wallace. Those suits, unlike Lord’s, name UM and Jackson Memorial as defendants.
But Lord’s suit was filed first, which means he will collect part of the settlement with the Justice Department. Both UM doctors, Yelen and Chen, will receive a portion of Jackson’s proposed settlement with the government. The amount of Jackson’s settlement in that case has not been disclosed.
SHALALA’S TENURE
In a recent court filing, Justice Department lawyers negotiating the settlement with UM brought up Shalala’s ongoing political campaign with Judge Altonaga as she considered unsealing the whistle-blower case.
“The government wishes to advise the [federal] court that the Lord and Chen/Yelen complaints contain allegations relating to former UM president and current Congresswoman Donna Shalala who is seeking reelection in the upcoming election on November 3, 2020,” Justice Department lawyers wrote in a status report filed with the judge last week. “Due to the proximity of the unsealing date to the election date, we wanted to bring this issue to the court’s attention.”
There was no explanation of the allegations but the Justice lawyers noted, “Congresswoman Shalala is not a party to this action or the proposed settlement with UM, and the Department of Justice takes no position as to the timing of the unsealing of the complaints in this matter.”
The judge unsealed the case one day before Election Day. (Poster's Note: she has lost her bid for re-election)
BY JAY WEAVER AND DANIEL CHANG
NOVEMBER 04, 2020 07:00 AM, UPDATED 8 HOURS 25 MINUTES AGO
UHealth provides more than 90 percent of the physicians at Jackson, which is the training hospital for UM’s Miller School of Medicine. For a time, the relationship grew strained, partly because UM purchased the former Cedars Medical Center across the street.
UHealth provides more than 90 percent of the physicians at Jackson, which is the training hospital for UM’s Miller School of Medicine. For a time, the relationship grew strained, partly because UM purchased the former Cedars Medical Center across the street. CARL JUSTE MIAMI HERALD STAFF
A federal lawsuit unsealed Monday after seven years of secrecy has revealed fraud allegations by a former University of Miami senior executive that the school’s healthcare system billed millions of dollars in unnecessary lab tests to Medicare and stuck patients with hidden charges for clinic visits.
The U.S. Justice Department began investigating the allegations after they were first raised by the former chief operating officer of the UM Miller School of Medicine, Jonathan “Jack” Lord, who filed a whistle-blower lawsuit in 2013.
Lord accused the university of filing false claims with Medicare for unnecessary organ transplant tests and overcharging patients for clinic visits during a period when UM was struggling with massive debt after undertaking an ambitious transformation of the medical school into a sprawling academic healthcare system under past president Donna Shalala. She is now a Miami congresswoman who suffered a surprising upset in her race for reelection late Tuesday.
Court records show UM and the Justice Department, which joined Lord’s lawsuit, have reached an “agreement in principle.” The proposed settlement is likely to cost the private university $22 million to resolve the so-called False Claims Act case.
UM said in a prepared statement, “We hope to finalize the settlement in the coming weeks,” and added that the university has not admitted any wrongdoing.
Lord, who was forced out by Shalala seven years ago, is expected to receive about $4 million as a reward for initiating the suit against his former employer.
Significantly, the imminent settlement means that the Justice Department has adopted a handful of key allegations in Lord’s complaint against Coral Gables-based UM, which operates a medical school out of the public Jackson Memorial Hospital in Miami and a sprawling UHealth network across four counties. The lawsuit was unsealed Monday by order of U.S. District Judge Cecilia Altonaga.
The U.S. Attorney’s Office in Miami and Justice Department, which prosecuted Lord’s whistle-blower case, declined to comment about the planned settlement.
Lord’s suit claims that illegal practices were “not only well known to UM at the highest corporate level, but were encouraged” — accusations that triggered “parallel criminal and civil investigations” into UM’s allegedly fraudulent billing of Medicare for organ transplant surgeries and other patient services.
However, the criminal probe led by the FBI and the Department of Health and Human Services concluded without any charges against the university or any employee, according to several sources familiar with the investigation.
Under the proposed settlement, UM has agreed to pay the federal government civil damages for overcharging the taxpayer-funded Medicare program for pathology lab services at Jackson Memorial. Lord’s whistle-blower suit claims that UM’s labs improperly billed the Medicare program for thousands of unnecessary pathology tests involving kidney and other organ transplant surgeries.
The university has also agreed to pay the Justice Department for imposing a surcharge on patients at UM-affiliated medical offices without notifying them of the actual cost for each visit. The patients were charged an extra hospital-based fee — sometimes in the hundreds of dollars — for visits to doctors’ offices that were not located at UM’s hospital campus in Miami. The surcharge was incurred by the Medicare program, which serves the elderly and indigent.
UM’s planned settlement with the federal government will resolve potentially hundreds of millions of dollars in disputed false claims over lab tests and patient surcharges spanning nearly a decade.
The agreement will allow the Medicare program to keep most of UM’s settlement payment. Lord will receive about 20% of the payment under a Justice Department formula for False Claims Act cases.
Here are important steps patients can take to prevent fraudulent or mistaken billing and other problems, according to the Centers for Medicare and Medicaid Services. Fraud costs patients in the long run. BY CENTERS FOR MEDICARE AND MEDICAID SERVICES
The big losers are UM Health System’s patients, especially those who paid out of pocket or through private insurers for the hidden hospital-based fees at doctors’ offices and clinics affiliated with the university. The patients won’t receive any compensation because a planned class-action case for the fee surcharges could not be filed within the statute of limitations while the whistle-blower suit was still under seal in Miami federal court.
UM’s lawyer downplayed the false billing allegations and stressed instead that patients received quality care from the UHealth System.
“These allegations have absolutely nothing to do with patient care but mostly derive from disagreements over regulatory interpretation,” UM’s attorney, Dan Gelber, told the Miami Herald. “The government has never claimed the University failed to provide excellent care to its patients or that it billed for services it did not provide. All other allegations have been outright abandoned by the government.”
Until now, neither the university nor UHealth had ever been the target of a Justice Department probe alleging fraudulent billing, which is the centerpiece of Lord’s whistle-blower case.
In 2013, the university was ordered to refund $3.7 million to Medicare after a federal audit of its billing practices found the hospital overcharged the program in 2009 and 2010, according to a report by the U.S. Department of Health and Human Services Office of Inspector General.
Lord’s whistle-blower suit, filed under seal in July 2013 by his attorney, Jeffrey Sloman, names only the university as a defendant. Lord’s attorney, with the Miami law firm Stumphauzer Foslid Sloman, said he could not comment on the case until there is a settlement.
Lord, now 66, was the No. 2 executive at UM’s Miller School of Medicine before being forced out in January 2013. But he wasn’t the only UM employee who alleged wrongdoing by the university.
Separately from Lord, two senior UM medical school physicians, Joshua Yelen and Philip Chen, in the pathology department, filed similar whistle-blower lawsuits — as did a former finance director for Jackson Memorial, Mitchell Wallace. Those suits, unlike Lord’s, name UM and Jackson Memorial as defendants.
But Lord’s suit was filed first, which means he will collect part of the settlement with the Justice Department. Both UM doctors, Yelen and Chen, will receive a portion of Jackson’s proposed settlement with the government. The amount of Jackson’s settlement in that case has not been disclosed.
SHALALA’S TENURE
In a recent court filing, Justice Department lawyers negotiating the settlement with UM brought up Shalala’s ongoing political campaign with Judge Altonaga as she considered unsealing the whistle-blower case.
“The government wishes to advise the [federal] court that the Lord and Chen/Yelen complaints contain allegations relating to former UM president and current Congresswoman Donna Shalala who is seeking reelection in the upcoming election on November 3, 2020,” Justice Department lawyers wrote in a status report filed with the judge last week. “Due to the proximity of the unsealing date to the election date, we wanted to bring this issue to the court’s attention.”
There was no explanation of the allegations but the Justice lawyers noted, “Congresswoman Shalala is not a party to this action or the proposed settlement with UM, and the Department of Justice takes no position as to the timing of the unsealing of the complaints in this matter.”
The judge unsealed the case one day before Election Day. (Poster's Note: she has lost her bid for re-election)