University of Miami resolves Medicare government fraud case

UM pays $ 22 million to settle whistleblower claims.

The University of Miami (UM) is set to disburse $ 22 million in a civil settlement accusing the school of violating the False Disclosure Act by ordering medically unnecessary laboratory tests and making false claims about their laboratory as well as theirs Submits facilities off campus. The False Claims Act provides penalties for those who defraud government programs, and the Medicare fraud scheme effectively resolves the allegations raised in three lawsuits filed under the provisions of the Whistleblower Act. UM also has a corporate integrity agreement with the Department of Health and Human Services (DHS).

Jonathan “Jack” Lord of UM Miller School of Medicine filed an initial whistleblower lawsuit in 2013 for Medicare fraud. In 2020, it was unsealed after seven years, revealing allegations that the school’s health system billed millions of dollars in unnecessary laboratory tests and hit patients with hidden fees.

Photo by Armin Rimoldi from Unsplash

According to court records, the government found UM was implicated in Medicare fraud due to improper billing practices related to organ transplant testing and violated Medicare rules that require facilities to notify patients and federal regulators in writing of any surcharges. Court documents state: “Medicare regulations allow medical systems to convert doctor’s offices into hospital settings if they meet certain requirements. Billing as a hospital facility results in higher costs for the Medicare program and beneficiaries. Hospital facilities are required to notify Medicare beneficiaries explaining the financial implications of receiving services in hospital settings as opposed to doctor’s offices. “Instead,” UM “converted several medical practices into hospital facilities and then requested payment at higher rates without providing the beneficiaries with the necessary notification.”

The allegations also state, “UM has billed federal health programs for medically unnecessary laboratory tests for patients who received kidney transplants at the Miami Transplant Institute (MTI).” Finally, “UM has caused JMH to file excessive reimbursement claims for pre-transplant laboratory tests performed at MTI in violation of the related parties’ terms. These limit the reimbursement a vendor can receive for testing conducted by an affiliate to the actual cost of costs. “

“Healthcare providers who charge for medically unnecessary services and who knowingly break billing rules are contributing to rising health care costs,” said Assistant Attorney General Brian M. Boynton of the DOJ’s Civil Division. “The department will investigate and hold accountable those who seek to benefit at the expense of federal health programs and their beneficiaries.”

“Medical providers making fraudulent claims on our taxpayer-funded health programs not only violate public trust. You jeopardize the integrity of these programs, ”added acting US attorney Juan Antonio Gonzalez for the southern Florida district. “Our office will aggressively investigate any vendor who knowingly violates these billing rules, regardless of size.”

“Charging the Medicare program and patients by charging for medically unnecessary services will always attract the attention of my office,” promised special agent Omar Pérez Aybar of the Office of the Inspector General of the Ministry of Health and Human Services ( HHS-OIG). “Working with our law enforcement partners, our agents are committed to investigating suspected billing frauds that are causing huge costs to federal health programs and its beneficiaries.”


University of Miami pays $ 22 million to settle claims related to medically unnecessary laboratory tests and fraudulent billing practices

University of Miami pays $ 22 million on allegations of violating the False Claims Act

UM agrees to pay millions to resolve Medicare fraud allegations raised by whistleblowers

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