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AHS Hospital Corp. Agrees to Pay $8,999,999 to Settle Medicare Fraud Allegations
AHS Hospital Corp., a New Jersey-based healthcare provider, has agreed to pay $8,999,999 to settle allegations that they violated the False Claims Act, the Justice Department announced today.
The settlement resolves allegations that Overlook Hospital, owned and operated by AHS Hospital Corporation, and Atlantic Health Systems Inc., overbilled Medicare for patients who were treated on an inpatient basis when they should have been treated as either observation patients or on an outpatient basis.
This settlement partially resolves a False Claims Act suit filed by former employees of Overlook Hospital. U.S. ex rel. Doe et al. v. AHS Hospital Corp., et al., Civ. No. 08-2042 (D.N.J.). The whistleblower or qui tam provisions of the False Claims Act permit individuals, known as relators, to file these actions and share in a portion of the proceeds recovered by the federal government.
“We expect hospitals that participate in Medicare will bill for their services accurately and honestly,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division. “Hospitals have a responsibility to ensure that the Medicare rules are not abused and patients who should be treated as outpatients are not admitted as inpatients, increasing the hospitals’ reimbursements.”
“Billing Medicare for unnecessary inpatient services steals from taxpayers,” said Daniel R. Levinson, Inspector General for the U.S. Department of Health and Human Services, “Although that’s bad enough, it also requires hospitalizing people who don’t need it, causing inconvenience, discomfort and worse. The size of this settlement underscores the seriousness of the conduct.”
“Proper billing ensures fair compensation and protects Medicare dollars that are much needed for patient care,” said J. Gilmore Childers, First Assistant U.S. Attorney for the District of New Jersey. “Hospitals taking more than their entitled share of reimbursements, by improperly billing services as more expensive services, subject themselves to federal scrutiny.”
The case was handled by the U.S. Attorney’s Office for the District of New Jersey, the Civil Division, and the Office of Inspector General of the U.S. Department of Health and Human Services.
Mandatory Facts:
- Defendant/Respondent: AHS Hospital Corp.
- Criminal Charges: Violation of the False Claims Act
- City and State: New Jersey
- Date: (No specific date mentioned)
- Sentence/Outcome: $8,999,999 settlement
- Dollar Amount: $8,999,999
Key Facts
- State: New Jersey
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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