Health & wellness

Federal authorities report record fraud judgments, settlements in 2011

The federal government in fiscal year 2011 won or negotiated settlements in health care fraud cases totaling $2.4 billion, according to a report from the US departments of justice and health and human services. Authorities collected additional money from cases completed in prior years, recovering a record $4.1 billion.

“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” Health and Human Services Secretary Kathleen Sebelius said in a press release. “Our efforts strengthen the integrity of our health care programs.”

Two cases highlighted in the report were linked to Massachusetts. In one case, Beth Israel Deaconess Medical Center paid $233,932 to resolve a case alleging that it overbilled Medicare for injections of a drug used to treat prostate cancer, using a billing code under which the hospital would be paid nearly twice what it should have been for the drug, called Lupron.


Jamie Katz, interim senior vice president of compliance at the hospital, said in an e-mailed statement that the billing error was unintentional.

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“This is an isolated instance of not catching a change in code used to charge for a particular dosage of Lupron,” Katz said.

Beth Israel Deaconess Hospital-Needham paid $59,702 for a similar settlement. The report did not include all local cases. Find others here.

Last spring, CVS pharmacy agreed to pay about $17.5 million to the federal government and to 10 states, including Massachusetts, New Hampshire, and Rhode Island. The case alleged that the pharmacy chain billed state Medicaid programs for more than it was owed for prescriptions filled for certain beneficiaries.

In a statement last April, the company said it “denied engaging in any wrongful conduct and has settled the matter to avoid the expense and uncertainty of protracted litigation.”

Chelsea Conaboy can be reached at Follow her on Twitter @cconaboy.