Boston Medical Center to Pay $1.1 Million to Settle Fraud Allegations

The Justice Department says BMC billed insurance for more cancer drugs than it actually gave patients.

Photo by Kate Hannon on Flickr/Creative Commons

Photo by Kate Hannon on Flickr/Creative Commons

Boston Medical Center will pay $1.1 million to settle allegations of fraud, after it was accused of improperly billing Medicare and Medicaid.

In prepared remarks Friday, the Justice Department alleged that BMC had billed Medicare for more units of the expensive cancer drug Rituxan than it had actually administered to patients. BMC was also accused of billing Medicare for unneeded outpatient podiatry services, as well as submitting claims to Medicare and Medicaid for services at its pre-surgery treatment center that the hospital was already being reimbursed for.

U.S. Attorney Carmen Ortiz commended BMC for its cooperation throughout the federal investigation.

“The internal and external reviews demonstrated that the majority of the issues raised in the case had no validity,” the hospital told the Boston Business Journal. “However, there were limited issues of billing mistakes in pharmacy, podiatry and the pre-procedure clinic, consistent with the results of BMC’s own review. The inaccuracies in these cases were related to software and billing complexities and have been addressed and resolved.”

The allegations were first raised by a whistleblower, BMC’s former chief compliance officer, Kathleen Heffernan.