Attorney General William Tong and US Attorney Vanessa Roberts Avery announced on Tuesday that Northeast Medical Group (NEMG) and Yale New Haven Health Services Corp (YNHH) have entered into a civil settlement agreement with the federal and state governments in which they will pay $560,718 to resolve allegations they overbilled the federal Medicare and Connecticut Medicaid programs.
Northeast Medical Group is a physician and associated provider group affiliated with Yale-New Haven Health Services Corp, which owns several hospitals, including Bridgeport Hospital.
A whistleblower filed a lawsuit alleging that NEMG and YNHH had submitted false claims to Medicaid and Medicare for services purportedly provided at Bridgeport Hospital by doctors and mid-level providers – advance practice registered nurses and physician’s assistants – that were instead performed only by mid-level providers.
Services provided by mid-level providers alone are reimbursed at lower rates. A joint state and federal investigation of the allegations followed.
The government alleges that NEMG and YNHH submitted claims to the federal Medicare and Connecticut Medicaid programs for physician rate services provided by lower-level providers, and that NEMG and YNHH knew or should have known about this improper billing and failed to take adequate steps to stop it. To resolve these claims, NEMG and YNHH have agreed to pay $560,718. Medicaid’s share of the settlement is $110,042.
The whistleblower will receive 19 percent of the total settlement, in the amount of $106,536. The case resolved by this settlement is captioned U.S. and Connecticut ex rel. Cadariu v. Northeast Medical Group et al. (Docket No. 19-cv-904).
“Northeast Medical Group and YNHH allegedly submitted hundreds of thousands of dollars of claims to government healthcare programs at rates they knew or should have known they were not owed yet failed to correct their inflated billing practices. I thank the whistleblower for stepping forward to report these dubious claims and to protect our public healthcare dollars,” Attorney General Tong said in a release.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Government Program Fraud Section at 860-808-5040 or by email at [email protected]; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to [email protected].
Assistant Attorney General Rick Porter and Forensic Fraud Examiner Lisa Bailey, under the supervision of Gregory K. O’Connell, Chief of the Government Program Fraud Section, assisted the Attorney General in this matter. Assistant United States Attorney Sarah Gruber is prosecuting the case on behalf of the United States.