Maryland General Hospital: Cardiac Perfusion Overbilling and Known Overpayments
Maryland General Hospital agreed to pay $750,000 in its cardiac perfusion settlement to resolve allegations of overbilling for cardiac perfusion studies and retaining known overpayments. The bill was only the beginning of the government’s case. What the hospital did after learning it had been overpaid mattered too.
What the Maryland General Settlement Covered
The Justice Department alleged that Maryland General overbilled for cardiac perfusion studies performed from March 24, 2003 through December 23, 2009. The acute-care hospital in Baltimore was part of the University of Maryland Medical Systems Corporation.
Senior financial managers learned of the overpayments in February and August 2007, according to the department. Its announcement said evidence established that awareness and alleged that the hospital failed to return the money until the whistleblower case. The government said Medicare’s money stayed with the hospital after the people managing its finances knew it was owed back.
A private citizen brought the allegations through a qui tam case on behalf of the United States. The Justice Department announced the settlement on August 12, 2013.
Medicare paid the hospital, and taxpayers bore the cost of the alleged overbilling.
What Management Knew About the Overpayments
The government’s account put senior financial managers’ awareness at the center of the repayment allegation. That is a concrete point for someone whose work involves payments, adjustments or refunds: the hospital’s response after a problem reached management can be part of a whistleblower case.
For a finance employee, a dated communication can connect an identified overpayment to the people responsible for responding. A repayment record addresses what the hospital did afterward. We examine those records with the insider who understands the accounts, the communications and who could authorize the money to leave.
The useful detail is often in the difference between a document’s wording and what it meant to the people receiving it. An insider may know which payments a communication concerned, why it went to a particular manager and what response followed. We bring that explanation together with the billing and payment history, so the case shows the decisions behind the accounts.
How Much Is a Whistleblower Claim Worth?
A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. The Justice Department’s announcement states the whistleblower’s award in Maryland General’s case.
How Is Medicare Fraud Detected?
Insider information can connect a hospital’s bills to what management knew about them. Maryland General’s case began with a whistleblower, and the government’s account identified when the overpayment information reached senior financial managers.
A 2020 forensic accounting journal article, A Forensic Accountant’s Guide to the Most Potent Federal Laws Used Against Healthcare Fraud, explains why that access matters:
Complex financial crimes often cannot be detected without the assistance of those who possess knowledge of them.
The article identifies another contribution: knowledgeable whistleblowers supplement the government’s enforcement resources. An insider brings an understanding of how the business actually works, alongside the information about the suspected fraud.
For a case involving known overpayments, that knowledge gives the financial records a human explanation: who knew the money was owed back and what happened next. We work with the billing or finance insider to connect the services billed, payments received and management’s response. A hospital employee who understands those decisions has a reason to speak with experts who know how to build a whistleblower case around them.
You Saw Where the Overpayment Went
If you know a hospital identified Medicare overpayments and kept them, speak to one of our Whistleblower Experts about the overpayments the hospital kept. We build the case with you, bring in hospital billing whistleblower lawyers who understand repayment disputes, and stay beside you through the pursuit of a recovery.
