The offices of the U.S. Attorney for the District of Connecticut and the Connecticut Attorney announced a $560,718.48 settlement with Yale New Haven Health Services Corp. and Northeast Medical Group that resolves allegations that the medical institutions violated the federal and state False Claims Acts by submitting false claims to Medicare and Medicaid from July 2014 to June 2020.
According to the allegations, Medicare and Medicaid received claims for evaluation and management services billed by Northeast Medical hospitalist physicians to Bridgeport Hospital patients; the hospital is part of the Yale New Haven Health network and Northeast Medical is an affiliate of Yale and outsources its billing, coding, and compliance to the company.
However, these submissions did not satisfy certain billing requirements and should have been billed by mid-level providers. As a result, Yale and Northeast Medical improperly received reimbursements that were 10% to 15% higher than they should have been.
The information on this billing issue was raised by a former employee of Northeast Medical and she will receive $106,536.51 as her share of the recovery. Yale and Northeast Medical were not required to formally acknowledge wrongdoing as part of the settlement.
