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MIAMI---The University of Miami has entered into a civil settlement with the federal government relating to medical services rendered at Jackson Memorial Hospital by physicians working at the University of Miami's teaching hospital, providing for a payment to the government of over $2.27 million.
This civil settlement arose from an investigation and audit conducted by the Department of Health and Human Services of claims submitted by the University of Miami to the Medicare Part B Program for services provided to hospital inpatients rendered between June 1, 1995 and May 31, 1996. One hundred patient files were selected and all billed services for those patients were included in the audit. The results were then projected over all inpatient services billed to Medicare Part B during that time period. Additional claims were also reviewed related to services performed in 1997 through 1999.
The United States contends that the University of Miami submitted claims for services which it had represented had been personally and identifiably provided by University of Miami faculty when the University of Miami did not possess sufficient documentary evidence to support the claims, for claims which were improperly coded at a level of service that was not supported by the documentation of those services, and for services provided by the University of Miami faculty for which the University of Miami did not have any, or sufficient, documentation to satisfy the requirements of Medicare.
The government also contends that during the period from June 1, 1995 through Dec. 31, 1999, the University of Miami submitted claims for critical care services in situations where patients were not critically ill, where critical care services were not rendered, or where critical care services were insufficiently documented.
Lastly, the United States contends that during the period from June 1, 1995 through Dec. 31, 1999, U of M submitted claims for items which were billed in connection with neurosurgeries in circumstances where the services should not have been separately billed. 12-22-06
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© 2006 North
Country Gazette
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