Conn. Hospital Settles Civil Allegations Under The False Claims Act

February 15, 2005

Kevin O’Connor, United States Attorney for the District of Connecticut, and Richard Blumenthal, Connecticut Attorney General, announced that St. Francis Hospital and Medical Center, located in Hartford, Connecticut, has entered into a civil settlement agreement with the Government to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicaid program.

O’Connor explained that this case is part of “Operation Free Shot,” a continuing investigation by the Health Care Fraud Task Force. Operation Free Shot focuses on Connecticut health care providers who bill Medicaid and other insurance programs for childhood vaccines the providers received free-of-charge from the Vaccines For Children (VFC) program, a joint federal and state program that provides childhood immunizations.

Under the VFC Program, doctors and other health care providers receive free vaccines distributed by the Department of Public Health and agree not to bill Medicaid or any other third-party for the cost of the vaccines. The provider may recover a minimal fee for administrative costs associated with inoculating a child. The Government alleged that St. Francis Hospital and Medical Center billed Medicaid and other insurance plans for vaccine doses the hospital received for free from the VFC Program.

Pursuant to the civil settlement agreement, St. Francis will pay double damages to the United States and the State of Connecticut, in the amount of $299,363.66, in order to reimburse the Medicaid program for conduct occurring between February 1997 and March 2004. St. Francis also has agreed to reimburse the private insurance companies billed by the hospital for free vaccines, in the amount of approximately $6,000.

In addition, St. Francis has entered into a Certification of Compliance Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of the Medicaid and Medicare Programs.

O’Connor noted that Operation Free Shot involves coordination among various federal and state authorities and agencies, and praised in particular the cooperation and assistance provided by the Connecticut Department of Public Health and HealthNet, a Medicaid Managed Care Organization.

“Hospitals, medical practices and physicians that receive vaccines from the Government free of charge can not subsequently bill for the vaccinations – period,” O’Connor stated. “Billing systems for medical providers may struggle to keep up with constant changes to health care laws and insurance requirements, but providers must do everything in their power to bill fairly and accurately. Providers are encouraged to review all billing procedures, before the Government does it for you.”

In entering into the civil settlement agreement, St. Francis did not admit liability and the agreement indicates that the parties entered into the settlement to avoid the uncertainty and expense of litigation.

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