DOJ, Univ. of Pittsburgh Medical Center settle False Claims Act allegations for $957K

Federal prosecutors in western Pennsylvania this week announced that the

University of Pittsburgh Medical Center and its related visiting nurses association have agreed to pay the U.S. government nearly $1 million to settle allegations that UPMC violated the False Claims Act.

In an announcement made by the United States Attorney’s Office for the Western District of Pennsylvania, the Justice Department stated that the $956,590 settlement, which resolves the matter without the need to file civil litigation, results from a self disclosure by UPMC to prosecutors concerning referrals for home health services made by UPMC hospitals to UPMC VNA Home Health, a related UPMC division.

The federal government, based upon information provided by UPMC, asserted that it had enough to file civil claims against both UPMC and UPMC Home Health arising from Medicare billings for home health services that weren’t supported by documented face-to-face encounters with doctors or other authorized non-physician practitioners, as required under Medicare rules and regulations.

The matter had been investigated by the Office of Inspector General of the Department of Health and Human Services and the U.S. Attorney’s Office in Pittsburgh.

The ABC affiliate in Pittsburgh, WHTM Channel 27, quoted UPMC spokeswoman Gloria Kreps as saying that the healthcare organization admits no liability, that the billing errors were in a small minority of cases, and that the organization ultimately complied with the Medicare rules and regulations.

According to its website, the UPMC’s total operating revenue for fiscal 2012 was $10 billion. It had $9.5 billion in total assets that fiscal year.

The UPMC operates more than 20 individual hospitals comprising in excess of 4,500 licensed beds, and also runs more than 400 clinical locations in western Pennsylvania.

The UPMC has more than 5,500 affiliated physicians, including more than 3,300 employed by the healthcare organization, the website states.