The University of Miami agreed to pay $22 million to resolve allegations that it violated the False Claims Act by ordering medically unnecessary laboratory tests and submitting false claims through its laboratory and off-campus hospital-based facilities.
According to prosecutors, University of Miami converted several physician offices to hospital-based facilities to seek reimbursement at higher rates. While Medicare allows providers to convert offices to hospital-based facilities, they need to meet certain requirements and provide proper notice to CMS. Prosecutors claim University of Miami knowingly didn't provide the required notice and as a result submitted false claims related to its hospital facilities.
Prosecutors also alleged that the university billed federal healthcare programs for medically unnecessary laboratory tests for patients who received kidney transplants at an institute it operated with Jackson Memorial Hospital in Miami. Prosecutors said that when a patient checked in, the electronic ordering system triggered a pre-set number of tests to be run, but many were not necessary and "dictated by financial considerations rather than patient care."
In addition to the civil settlement, University of Miami agreed to enter into a corporate integrity agreement with HHS.