Mercy Hospital pays $1.5 million to settle Medicare overbilling case
U.S. Attorney for Maine Halsey B. Frank announced Wednesday that Mercy Hospital of Portland has entered into a civil settlement agreement with the United States and the State of Maine in which it will pay $1,514,000 to resolve allegations that it violated the federal and Maine False Claims Acts.
The settlement resolves allegations in United States v. Mercy Hospital that Medicare and MaineCare were overbilled for urinalysis drug screening tests ordered and performed at the former Mercy Recovery Center in Westbrook from 2011 through 2013, according to a news release from Frank’s office. In October 2013, Mercy and its affiliate, Mercy Recovery Center, were acquired by Eastern Maine Healthcare Systems.
The lawsuit alleged that Mercy falsely used a billing modifier code to receive payment for multiple same-day urinalysis drug screening tests at Mercy Recovery Center that did not arise from separate, medically necessary encounters with the same patients on the same days. The urinalysis drug screening tests should have been bundled and billed as one claim per each single patient encounter, the U.S. attorney’s office stated in a news release.
Instead, Mercy separately billed for the urinalysis drug screening tests on a per-test basis. As a result, Medicare and MaineCare overpaid Mercy on multiple claims.
Mercy cooperated with the investigation, the U.S. attorney’s office stated. In addition, Mercy and EMHS implemented enhanced internal compliance measures in response to the overbilling issue.
The case was investigated by the Office of Inspector General for the U.S. Department of Health and Human Services.
The U.S. attorney’s office stated that federal and state authorities encourage health care providers to cooperate with its investigations of the possible submission of improper claims to federal and state programs.
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