Baptist Health Systems has agreed to pay $3,675,000 to resolve a whistleblower’s allegations that it violated the False Claims Act by failing to disclose insurance coverage applicable to treatment it provided to Medicare beneficiaries.
Under Medicare rules, providers are required to disclose the fact that a patient has other insurance when the provider submits claims to Medicare. In these instances, the claims are processed through the applicable insurance policy, with Medicare sometimes paying for the patient’s deductible or other out of pocket costs. By failing to disclose the existence of applicable insurance coverage, Baptist Health Systems caused the government to overpay Medicare claims from 2003 through 2007.
The whistleblower who exposed this practice through the filing of a False Claims Act lawsuit will receive $661,500 from the settlement proceeds.
For more information on this case, click here: http://www.justice.gov/usao/txw/news/2013/Baptist_Hospital_SA_civil_settlement.html