NEW HAVEN, CT — Yale New Haven Health Services and Northeast Medical Group have paid more than half a million dollars to “settle allegations” that they both violated false claims laws for submitting false claims to Medicare and Medicaid.
US Attorney for Connecticut Vanessa Roberts Avery and CT Attorney General William Tong announced that Yale and Northeast entered into a civil settlement agreement with the federal and state governments and have paid $560,718.48. Both were alleged to have billed for medical services that should have been billed by lower-reimbursed, per-employee mid-level providers.
Yale New Haven Health Services Corp. is a not-for-profit health system that owns several acute care hospitals, including Bridgeport Hospital. Northeast Medical Group, Inc., employs internal medicine hospitalists and mid-care providers at Bridgeport Hospital. Northeast Medical is an affiliate of Yale and outsources its billing, coding and compliance to Yale, a press release from the Department of Justice noted.
The federal and state governments allege that, between July 2014 and June 2020, Yale and Northeast Medical violated federal and state false claims laws by submitting false claims to Medicare and Medicaid for evaluation and management services billed by Northeast Medical hospitalists to Bridgeport Hospital patients that did not meet certain billing requirements and instead should have been billed by mid-tier providers, according to Justice. As a result, Yale and Northeast Medical improperly received 10 to 15 percent higher Medicare and Medicaid reimbursements for allegedly falsely billed hospitalist services, it noted. To resolve their liability, Yale and Northeast Medical have paid $560,718.48, Justice and the State AG said.
The False Claims Act claims resolved in the settlement were originally brought in a whistleblower lawsuit under provisions of the False Claims Act, which allow private individuals to sue on behalf of the government and share in any recovery.
The relative (whistleblower), a former Northeast Medical employee, will receive $106,536.51 as her share of the recovery. The case resolved by this settlement was captioned US ex rel. Cadariu v. Northeast Medical Group et al. (Docket No. 19-cv-904).
The matter was investigated by the Office of Inspector General of the Department of Health and Human Services. The case is being prosecuted by Assistant US Attorney Sarah Gruber and Assistant Attorney General Rick Porter of the Connecticut Attorney General's Office.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.
