Beth Israel Settles for $5.3M for 'Improper' Medicare Claims

Beth Israel Deaconess Medical Center (BIDMC) has agreed to pay the United States $5.315 million to settle allegations that it charged Medicare cases improperly from 2004 to 2008, according to a statement from the US Attorney's Office. 

United States Attorney Carmen M. Ortiz  said in a statement that the hospital billed Medicare for inpatient admissions that should have been billed as lower reimbursed outpatient or observation services.
These inpatient stays were one day in length, with patients admitted for 
congestive heart failure, chest pain, and certain digestive and nutritional disorders. All patients were only briefly admitted for the purpose of observation. 

In addition, the hospital was also accused of submitting claims to Medicare for less-than-one day (zero day) stays that should have been billed as outpatient or observation services. 

Medicare reimburses hospitals, like BIDMC, at significantly higher amounts for inpatient admissions compared to outpatient or observation services. 

BIDMC has not admitted liability or wrongdoing in connection with the settlement.  

“Today’s settlement furthers two critical purposes: ensuring that precious federal health care dollars are spent appropriately and in accordance with the law, and emphasizing that patient needs, not the bottom line, must be the basis for treatment decisions,” said U.S. Attorney Ortiz. 

"When hospitals unnecessarily admit Medicare patients for short inpatient stays when the appropriate treatment would be outpatient or observation care, they improperly boost hospital profits at significant expense to taxpayers and patients," said Susan J. Waddell, Special Agent in Charge of the Department of Health & Human Services, Office of Inspector General. "We are committed to uprooting such schemes to eliminate waste in federal health care programs."  

This matter was investigated by Investigator Kristen Israelson of the Department of Health & Human Services, Office of Inspector General, Boston Regional Office of Investigations.  It was handled by Assistant U.S. Attorney Jennifer Cardello and Special Assistant U.S. Attorney John O’Brien, both from Ortiz’s Affirmative Civil Enforcement Unit, and Senior Trial Counsel Marie Bonkowski of the Commercial Litigation Branch of the Justice Department's Civil Division.