WASHINGTON DC Nov 282012—Baylor University Medical Center, Baylor Health Care System, andHealthTexas Provider Network (collectively, Baylor) have agreed to pay theUnited States $907,355 to settle allegations that Baylor submitted false claimsto Medicare, the Civilian Health and Medical Program of the Uniformed Services(TRICARE), and the Federal Employees Health Benefit Program (FEHBP) for variousradiation oncology services, including intensity modulated radiation therapy,the Justice Department announced today. Intensity modulated radiation therapyis a sophisticated radiation treatment indicated for specific types of cancerwhere extreme precision is required to spare patients’ surrounding organs orhealthy tissue.
The government alleges that Baylor University submittedimproper claims to Medicare from 2006 through May 2010 in which Baylor doublebilled Medicare for several procedures affiliated with radiation treatmentplans; billed for certain high reimbursement radiation oncology services when adifferent, less expensive service should have been billed; billed forprocedures without supporting documentation in the medical record; andimproperly billed for radiation treatment delivery without corroboration ofphysician supervision.
“Physicians who participate in Medicare must bill for theirservices accurately and honestly,” said Stuart F. Delery, Principal DeputyAssistant Attorney General for the Justice Department’s Civil Division. “TheDepartment of Justice is committed to ensuring that federal health care fundsare spent appropriately.”
Principal Deputy Assistant Attorney General Delery alsonoted that the settlement with Baylor was the result of a coordinated effortamong the Justice Department’s Civil Division, the U.S. Attorney’s Office forthe Northern District of Texas, the Department of Health and Human Services’Office of Inspector General, FBI, and Defense Criminal Investigative Services.
U.S. Attorney for the Northern District of Texas Sarah R.Saldaña praised these investigative efforts and said, “This civil recovery is atestament to the efforts of the Department of Justice to hold all parties,regardless of position, accountable for the submission of improper claims tofederal health care programs.”
This resolution is part of the government’s emphasis oncombating health care fraud and another step for the Health Care FraudPrevention and Enforcement Action Team (HEAT) initiative, which was announcedby Attorney General Eric Holder and Kathleen Sebelius, Secretary of theDepartment of Health and Human Services in May 2009. The partnership betweenthe two departments has focused efforts to reduce and prevent Medicare andMedicaid financial fraud through enhanced cooperation. One of the most powerfultools in that effort is the False Claims Act, which the Justice Department hasused to recover $10.1 billion since January 2009 in cases involving fraudagainst federal health care programs. The Justice Department’s total recoveriesin False Claims Act cases since January 2009 are over $13.8 billion.
The claims settled by this agreement are allegations only,and there has been no determination of liability.
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