Vermont Business Magazine Brattleboro Memorial Hospital (BMH) has agreed to a civil settlement with the Federal government, the State of Vermont, and a former employee in which it has agreed to pay $1,655,000 to resolve allegations that it violated the federal False Claims Act with regard to coding of claims submitted for certain laboratory tests performed between January 2012 and September 2014. Specifically, that, in some instances, the clinicians’ orders for laboratory tests did not appear to adequately document the diagnosis code included on the billing claim form as required.
Beginning in early 2016, BMH undertook a detailed internal investigation of the issue, and, in June 2016, BMH voluntarily self-disclosed to the Office of the Inspector General for the U.S. Department of Health and Human Services (OIG) that BMH received overpayments as a result of this billing issue. These issues were not present in claims submitted after September 2014 as a result of internal corrective actions taken.
BMH fully cooperated with the subsequent OIG investigation. There have been no allegations that the services billed for were not provided or unnecessary; only that they were not properly documented. In reaching this settlement agreement, BMH does not admit to any intentional wrongdoing.
“BMH has made substantial investments within our Patient Financial Services department to address the matter,” states Jonathan Farina, BMH Chief Compliance Officer. “We take issues like this very seriously, and invest considerable time and resources into creating a robust, compliant billing process. Since learning of this billing issue, BMH improved both systems and personnel operations to correct the problem and ensure that we are doing our utmost to comply with the complex requirements for proper billing to all payers.”
Source: February 26, 2018, (Brattleboro, VT) – Brattleboro Memorial Hospital