Sixteen U.S. hospitals and their parent companies have agreed to pay the U.S. $15.69 million collectively to resolve allegations brought by a whistleblower under the False Claims Act that they fraudulently billed Medicare for services that were not medically reasonable or necessary. The case concerns claims for reimbursement the hospitals made to Medicare for Intensive Outpatient Psychotherapy services. Medicare pays for an appropriate course of the psychotherapy services when a number of specific requirements are met, the most notable being that the services provided are needed for the diagnosis and treatment of the patient’s condition. The whistleblower lawsuit alleged that from ... Read More
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