A Baltimore hospital has agreed to settle a federal False Claims Act lawsuit brought by a whistleblower who alleged the hospital overbilled Medicare through the misuse of billing codes, resulting in higher reimbursements from the federal health care program.
St. Agnes Healthcare will pay the U.S. government $122,928 to resolve claims made by Dr. Jonathan Safren, a former St. Agnes cardiologist. Dr. Safren’s allegations were investigated and ultimately supported by the U.S. Attorney’s Office in Maryland, the Department of Health and Human Services, and other federal agencies.
According to the whistleblower complaint, St. Agnes acquired a medical practice consisting of 12 cardiologists in 2011. After the acquisition, the cardiologists became employees of St. Agnes, but continued to treat their patients through St. Agnes affiliate Maryland Cardiovascular Specialists.
Medicare rules allow a higher rate of reimbursement for certain services for new patients than for old or “established” patients.
The whistleblower complaint alleged that from June 3, 2011, through June 3, 2014, St. Agnes submitted claims to Medicare for the patients of the 12 cardiologists by improperly coding them as new patients instead of as old patients. By using “new patient” codes instead of “existing patient” codes, the hospital was able to collect more in reimbursements from Medicare, the U.S. Attorney’s Office said.
Dr. Safren will receive a whistleblower award of $20,000 for filing the False Claims Act lawsuit on behalf of the federal government and helping recover vital taxpayer funds for Medicare.