Posted and filed under FWA, Healthcare.

On May 31, 2016 the US Attorney’s Office for the District of New Jersey published a press release regarding the latest settlement for health care fraud in the state involving Saint Michael’s Medical Center and four individual physicians who submitted false claims for procedures that were not deemed medically necessary. These allegations come from a lawsuit submitted under the Whistleblower provisions of the False Claims Act, and go further on to suggest that the hospital and physicians knowingly submitted these false claims for a number of cardiac procedures including stents, catheterizations, and percutaneous coronary intervention (angioplasty).

These false claims and unnecessary procedures were billed under a number of codes, including the following: G0290 (HCPCS), and CPT codes 92980, 92982, 92920, 93454, 92928, 93508, 93458, 93510, 93455, 37205, and 78452.

The false claims in question were billed to both Medicare and Medicaid, going as far back as January 1, 2009, extending to January 1, 2015. While these services and false claims were performed by six individual physicians, only four were named and disclosed in the lawsuit and preceding Letters to the US Attorney’s Office. Saint Michael’s Medical Center was issued to pay a sum of $450,000 to Medicaid and Medicare’s state and federal funds in order to settle the suit, with no determinations of lability to be made. Of the $450,000 sum, $427,500 is to be paid to the United States, with the remaining $22,500 going directly to the state of New Jersey.

U.S Attorney Fishman has made great strides with health care fraud after taking office in the NJ US Attorney’s Office, including the development of a Health Care and Government Fraud Unit utilized to handle investigations and offenses involving health care fraud. Since 2010, the unit has recovered well over $1.2 billion from settlements, fines, and other legal payouts under the False Claims Act and other regulated statutes.

Read the full Stipulation and Order of Settlement.