Robert Wood Johnson University Hospital Hamilton will pay $6.35 million to settle two whistleblower lawsuits alleging that the New Jersey hospital inflated outlier billings to Medicare, the Department of Justice announced today.
The two lawsuits filed against RWJUHH alleged that the hospital inflated charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid. DOJ intervened in both suits in January 2008.
"Taxpayer dollars should go toward quality healthcare, not wasted on fraud and abuse," said Tony West, assistant attorney general for the civil division of the Department of Justice, in a media release. "As the settlement announced today demonstrates, the Justice Department is committed to pursuing those who defraud Medicare and drive up the costs of healthcare."
When asked to comment about the case, RWJUHH President and CEO Skip Cimino said, "Robert Wood Johnson University Hospital Hamilton has resolved the outstanding Medicare Reimbursement issue with the government and looks forward to continuing its service to the community. The settlement resolves the entire case brought by the government. In the Settlement Agreement, the hospital expressly denies any wrongdoing or admission of the government's claims."
The whistleblowers in the two suits will split more than $1.1 million of the total recovery.
The Justice Department said its total recoveries in False Claims Act cases since January 2009 have topped $3 billion. Since 2006, DOJ has recovered more than $1.1 billion from hospitals that it alleged engaged in outlier fraud, it added.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.