Prosecutors allege the specialty hospital improperly billed Medicare and the Massachusetts Medicaid program for office visits from January 2012 to February 2020. Specifically, prosecutors said Massachusetts Eye and Ear billed for both the procedure and an office visit for nasal endoscopies and laryngoscopies. However, billing for office visit claims and the procedure are not permitted under federal law.
“Medicare and MassHealth do not permit billing for such office visits in addition to billing for the procedures, except under special circumstances that were not present here,” the Justice Department stated.
The settlement resolves allegations brought from a whistleblower. The whistleblower will receive 15 percent of the settlement.
More articles on legal and regulatory issues:
6 sentenced in $8M pharmacy fraud scheme
9 lawsuits have challenged $13B Change Healthcare, UnitedHealth deal
Patient recruiter gets 10-year prison sentence for telemedicine fraud
