FL health system settles Medicare fraud charges

Florida public health organization Jackson Memorial Health System, parent of the 1,776-bed public hospital behemoth Jackson Memorial Hospital, has agreed to pay $14.25 million to settle Medicare cost reporting fraud allegations with the U.S. attorney in Los Angeles. The settlement comes as part of an ongoing investigation that has implicated more than 20 hospitals and pulled in settlements of about $50 million. Jackson Memorial admitted no wrongdoing, and noted that the alleged discrepancies occurred well before its current administration was in place, vowing that all future billings would be squeaky clean.

The case came about as the result of a whistleblower lawsuit filed in 1998 by a former employee of financial consulting firm Healthcare Financial Advisors (HFA), which named dozens of hospitals as participating in a reimbursement fraud scheme. HFA was in the business of reopening closed Medicare cost reports and analyzing them to see if the firm could recover any additional reimbursement. The whistleblower, Mark Razin, alleged that HFA and the hospitals were deliberately making use of unallowable or reopened cost reports, getting wrongful overpayments as a result.

To learn more about the case:
- read this article from Modern Healthcare (sub. req.)