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UMiami to Pay $22M to Settle Medicare Fraud Allegations

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The University of Miami (UM) has agreed to pay $22 million to settle claims that it was in violation of the False Claims Act for ordering unnecessary lab tests and fraudulent billing.

According to court documents, the university engaged in three separate illegal practices in violation of the False Claims Act.

One charge states that UM turned many of its physicians offices into hospital facilities, resulting in higher costs targeting Medicare beneficiaries.

While legal, Medicare requires hospital facilities to notify recipients of the higher costs of receiving medical services there. The government asserted that UM converted many physicians offices and reaped the benefits without properly advising Medicare beneficiaries.

UM is also said to have billed federal healthcare programs for unnecessary laboratory procedures involving kidney transplant patients at the Miami Transplant Institute. 

The government also charges that UM played a role in massive reimbursement claims submitted by Jackson Memorial Hospital (JMH). The allegation states that UM offered to allow its surgeons to perform surgeries at JMH if the surgeons acquired “pre-transplant laboratory tests from UM at inflated rates.”

UM Settlement

Miami Herald reported that the US Department of Justice began investigating the allegations after former chief operating officer of the UM Miller School of Medicine filed a whistle-blower lawsuit in 2013. 

“Medical providers who submit fraudulent claims to our taxpayer-funded health care programs not only violate the public’s trust, they compromise the very integrity of these programs. Our office will aggressively pursue investigations against all providers who knowingly violate these billing rules no matter their size,” said Acting US Attorney Juan Antonio Gonzalez in a press release

“Health care providers who charge for medically unnecessary services and knowingly violate billing rules contribute to the soaring cost of health care,” Acting Assistant Attorney General Brian M. Boynton added.

In addition to agreeing to the $22 million settlement, UM will also enter a corporate integrity agreement with the Department of Health and Human Services.

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