Houston's United Memorial Medical Center (UMMC) has consented to fork over $2 million in settlement of charges that it improperly billed the government for COVID-19 tests and exaggerated costs for certain hospital stays. The allegations claim UMMC also engaged in double billing, hitting the government for tests that had already been billed to state or city entities.
A chunk of the settlement will come out of the wallet of UMMC principal Ravishanker Mallapuram, as reported by the Justice Department. The settlement also includes a commitment to make additional payments contingent on certain factors, although the details of these payments have not been disclosed. This hefty sanction comes in the wake of accusations that the healthcare provider tried to quickly rake in millions by methods deemed unlawful.
"This over $2 million settlement is significant," U.S. Attorney Alamdar S. Hamdani of the Southern District of Texas said. He strongly criticized UMMC for its financial misconduct, stating, “We depend upon medical providers to be good stewards of a community’s healthcare services and of the federally funded programs that pay for those services. UMMC made millions by overbilling those health care programs and intentionally double billing for COVID-19 testing. Instead of returning those monies to America’s taxpayers, they pocketed the money for themselves. Finding the wrongdoing and lost monies in these types of cases involves complexities akin to playing three-dimensional chess, but know this, the SDTX will not stop in its quest for justice until it can claim checkmate.”
Medicare and Tricare periodically hand out supplemental "cost outlier" payments to encourage hospitals to adequately treat patients requiring more costly care. However, UMMC has been accused of upping its inpatient charges and fudging its Medicare cost reports to unlawfully maximize these payments. According to the claims, the hospital also failed to reimburse the federal programs for the excessive payments it had already pocketed.
The healthcare provider has agreed to settle allegations of submitting claims to the Health Resources and Services Administration's Uninsured Program for COVID-19 testing, while already having received reimbursements for these tests from either the State of Texas or the City of Houston. "Hospitals and other providers who participate in federal health care programs have an obligation to the taxpayers to ensure that they are billing appropriately," asserted Brian Boynton, acting head of the Department of Justice's Civil Division.
The whistleblower who set the wheels in motion for this case, former UMMC employee Ryan Griffin, is set to receive $300,000 from the settlement. The recovered funds are a testament to the effectiveness of the qui tam provisions of the False Claims Act, which empower individuals with knowledge of fraud against the government to file lawsuits on behalf of the United States and share in the financial recovery.
