Boston Medical Center and two of its physician practice organizations have agreed to pay $1.1 million to resolve allegations made by a former chief compliance officer that they improperly billed Medicare and Medicaid, the U.S. Attorney's Office has announced.
Officials claimed Boston Medical billed Medicare for more units of Rituxan, an expensive drug used to treat cancer, than they actually used for patients. Boston Medical also allegedly billed Medicare and Medicaid for services at its pre-surgical treatment center even though the global fee for the subsequent surgeries covered those same treatments. Finally, the allegations say Boston Medical submitted claims to Medicare for outpatient podiatry services, even though the supporting documentation failed to support that the services were needed, authorities said.
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According to the U.S. Attorney's office, when Boston Medical learned they were under investigation they informed authorities that they were already looking into the Rituxan issue, and were about to audit the pre-surgical treatment billing issue as well. Boston Medical cooperated with the Department of health and Human Services as well as the Office of the Inspector General on all investigations.
Boston Medical's former Chief Compliance Officer Kathleen Heffernan brought the claims to light. The False Claims Act permits people to sue on behalf of the government for false claims for government funds, though the U.S. Attorney's office did not release information on what share of the settlement Heffernan would receive.
Twitter: @BethJSanborn