Medical Center ordered to pay $2M for alleged false claims, double billing COVID-19 tests
HOUSTON - United Memorial Medical Center LLC has agreed to pay $2 million, along with additional contingent payments, to settle alleged violations of the False Claims Act.
UMMC has operated hospitals in the Houston area before and is accused of making excessive claims for cost-outlier payments from government health care programs. Additionally, they are alleged to have double-billed the government for COVID-19 tests that were also billed to the State of Texas or the City of Houston.
According to the UMMC and the United States agreement, the settlement funds, totaling over $2 million, will be paid by one of UMMC’s principals, Ravishanker Mallapuram. UMMC has guaranteed the payment of these funds. U.S. Attorney Alamdar S. Hamdani for the Southern District of Texas stated that the settlement is significant.
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"This over $2 million settlement is significant," said U.S. Attorney Alamdar S. Hamdani for the Southern District of Texas (SDTX). "We depend upon medical providers to be good stewards of a community’s healthcare services and of the federally funded programs that pay for those services. The case alleges UMMC made millions by overbilling those health care programs and intentionally double billing for COVID-19 testing. Instead of returning those monies to America’s taxpayers, they allegedly pocketed the money for themselves. Finding the wrongdoing and lost monies in these types of cases involves complexities akin to playing three-dimensional chess, but know this, the SDTX will not stop in its quest for justice until it can claim checkmate."
The settlement also addresses allegations that UMMC manipulated charges for inpatient care to receive supplemental reimbursement from Medicare and Tricare, known as "cost outlier" payments. UMMC is accused of concealing and avoiding reimbursement obligations for excessive outlier payments its hospitals received.
According to the U.S. Attorney's Office release, UMMC has agreed to settle allegations of submitting claims to the Health Resources and Services Administration’s Uninsured Program for COVID-19 testing services, despite already being reimbursed by the State of Texas or the City of Houston.
Acting Special Agent in Charge Gregory P. Shilling of the Defense Criminal Investigative Service (DCIS) Southwest Field Office stated the commitment to rooting out fraud schemes that waste taxpayer resources, particularly those intended for the healthcare of service members through the DOD's taxpayer-funded healthcare program, TRICARE.
The settlement stems from a lawsuit brought by Ryan Griffin, a former UMMC employee, under provisions of the False Claims Act, allowing private citizens to bring a lawsuit on behalf of the United States. Griffin will receive $300,000 as part of the settlement.