The District of Columbia has sidestepped an oncoming lawsuit by the U.S. Department of Health and Human Services (HHS) concerning overbilling by Saint Elizabeth’s Hospital in 1997 and 1998. An HHS audit of Medicare claims submitted by the hospital during the two year period revealed that St. Elizabeth’s received millions in overpayments for improper claims submitted by the hospital to the agency. Under the False Claims Act, the District of Columbia could have been liable for treble damages in addition to civil penalties. The settlement does not require reimbursement to HHS for any of the overpayments received by the hospital, but it does force the District to forfeit all payments owing by HHS for services rendered prior to October 1, 2006. The hospital will be permitted to resume billing of Medicare for services provided after the October 1, 2006 cutoff.
The hospital will also be required to observe a five-year Corporate Integrity Agreement with HHS that mandates specific improvements in billing and auditing procedures along with extensive employee training and the establishment of an anonymous compliance hot line.
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