The U.S. Attorney's Office for Connecticut announced that New Milford Hospital, a part of Western Connecticut Health Network, made a settlement with the government to pay $471,933 to resolve allegations the hospital violated the federal False Claims Act.
The government claims New Milford billed the Medicare system too much for medicine used to treat prostate cancer in men or endometriosis and fibroids in women. Medicare reimburses more money for the female related medicine, and the goverment said New Milford Hospital was regularly billing the government as if the medicine was going to women, when it was being used to treat men.
The government claims New Milford Hospital figured out it was doing this, conducted its own internal investigation, discovered the false billing, but never alerted Medicare about the problem or attempted to pay back the money. Federal laws changed in 2009 and 2010 saying if a hospital was over paid by Medicare and the hospital figured it out, it was obliged by law to report it within 60 days.
The following statement was issued by Andrea Rynn, director of public and governmental relations with Western Connecticut Health Network, parent company of New Milford and Danbury hospitals. "The Lupron billing codes and procedures are among thousands issued by Medicare. New Milford Hospital, like a number of other hospitals in CT and around the country, did not properly follow these complex guidelines.
Once the issue was raised by the DOJ, the Hospital gave its full cooperation to the investigation. We felt that settling the matter promptly was the most appropriate course of action. New Milford Hospital's compliance program has been significantly strengthened since its affiliation with Danbury Hospital and we will collectively make every effort to avoid a similar problem in the future."
To resolve its liability under the False Claims Act, New Milford Hospital will pay $471,933 in order to reimburse the Medicare program for conduct occurring between February 1, 2001 and April 20, 2009. In entering into the civil settlement agreement, New Milford Hospital did not admit liability.
New Milford Hospital is the third Connecticut hospital this year to settle allegations involving improper billing to Medicare for Lupron injections. In April 2011, Masonicare Health Center in Wallingford settled allegations for $447,776, and in August 2011, Saint Francis Hospital and Medical Center in Hartford settled allegations for $516,527.