California hospital to pay $11.4M, settle whistleblower allegations

San Mateo (Calif.) Medical Center will pay $11.4 million to resolve allegations of improperly submitting claims for inpatient admissions, the U.S. Justice Department said Aug. 6.

Prosecutors allege that San Mateo Medical Center violated the False Claims Act by submitting claims to Medicare for noncovered inpatient admissions. In particular, prosecutors claim that from Jan. 1, 2013, to Feb. 28, 2017, the medical center admitted patients that didn't need inpatient care, including those who were admitted for reasons other than medical status. The medical center allegedly billed Medicare for these admissions despite knowing that Medicare does not reimburse these cases.

"Billing for non-covered hospital stays results in a misuse of federal dollars," said acting Assistant Attorney General Brian Boynton of the Justice Department's civil division. "Today’s settlement demonstrates our continuing commitment to ensure that Medicare pays only for services that are eligible for reimbursement."

As part of the settlement, the medical center also entered into a five-year corporate integrity agreement with HHS, requiring San Mateo Medical Center to have someone annually review inpatient admissions billed to Medicare. 

The settlement resolves claims brought by whistleblower Felix Levy, a former employee of the medical center. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars