Baylor Univ. hospital pays over $900,000 to settle False Claims Act allegations involving oncology claims

by Ben Vernia | November 27th, 2012

On November 27, the Department of Justice announced that Baylor University Medical Center had agreed to pay more than $900,000 to resolve allegations that it overbilled federal health care programs for radiation oncology services. According to DOJ’s press release:

Baylor University Medical Center, Baylor Health Care System and HealthTexas Provider Network (collectively, Baylor) have agreed to pay the United States $907,355 to settle allegations that Baylor submitted false claims to Medicare, the Civilian Health and Medical Program of the Uniformed Services (TRICARE) and the Federal Employees Health Benefit Program (FEHBP) for various radiation oncology services, including intensity modulated radiation therapy, the Justice Department announced today. Intensity modulated radiation therapy is a sophisticated radiation treatment indicated for specific types of cancer where extreme precision is required to spare patients’ surrounding organs or healthy tissue.

The government alleges that Baylor University submitted improper claims to Medicare from 2006 through May 2010 in which Baylor double billed Medicare for several procedures affiliated with radiation treatment plans, billed for certain high reimbursement radiation oncology services when a different, less expensive service should have been billed, billed for procedures without supporting documentation in the medical record, and improperly billed for radiation treatment delivery without corroboration of physician supervision.

The case apparently arose from a government investigation, and not from a whistleblower’s suit.

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