The state’s largest operator of acute-care hospitals and an affiliate have agreed to settle a lawsuit brought by state and federal governments for alleged violations of the False Claims Act.
According to authorities, Yale New Haven Health Services Corp., a nonprofit health system that owns seven acute-care hospitals, including Bridgeport Hospital, and an affiliate, Northeast Medical Group Inc., which provides physicians, nurses and physician assistants at Bridgeport Hospital, submitted false claims to Medicare and Medicaid for services billed by physicians when the services should have been billed by mid-level providers at a lower reimbursement rate.
Yale and Northeast Medical agreed to settle the lawsuit and have paid $560,718 to the state and federal government.
According to authorities, between July 2014 and June 2020, Yale and Northeast Medical violated the federal and state False Claims Acts by submitting false claims that were billed at the physician rate. The entities received Medicare and Medicaid reimbursements that were 10% to 15% higher even though the work was done by nurses and physician assistants.
The allegations were originally brought in a lawsuit filed under the whistleblower provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government and to share in any recovery.
The whistleblower, a former employee of Northeast Medical, will receive $106,536 of the settlement.
People who suspect healthcare fraud are encouraged to report it by calling 1-800-HHS-TIPS.
