A U.S Justice Department case against the University of Miami that took eight years to settle requires UM to pay about $22 million to the federal government, with half of it going to the taxpayer-funded Medicare program for the elderly and disabled.
A news release citing highlights of the 15-page settlement agreement said that UM was accused of fraudulently billing millions to the Medicare program for unnecessary transplant lab tests and inflated doctors’ fees, even after federal regulators had caught UM hiding the higher charges from patients.
The UM case was led by civil divisions at the Justice Department and U.S. Attorney’s Office in Miami, along with the Health and Human Services Office of the Inspector General and other government agencies.
The university must also pay the state of Florida about $325,000 under the terms, with half of that amount going to the Medicaid program for the indigent.
Jackson Memorial Hospital, which has a joint operating agreement with UM’s medical school to provide doctors and other services including organ transplant lab tests, must also pay $1.1 million to the federal government, according to the agreement.
It also includes a stipulation known as a corporate integrity agreement designed to prevent UHealth and UM’s own hospital from filing false claims with Medicare again.
The DOJ began investigating the allegations after they were first raised by the former chief operating officer of the UM Miller School of Medicine, Jonathan “Jack” Lord, who filed a whistleblower lawsuit in 2013 and is expected to receive about $4 million of the settlement as a reward for initiating the suit against his former employer.
Lord’s lawyer, Jeffrey Sloman, a former U.S. attorney in Miami, issued a statement condemning UM’s fraudulent billing practices and unnecessary lab tests.
“Tens of billions of dollars are lost annually to fraud, waste and abuse, and Miami is the Medicare fraud capital of the United States,” Sloman said. “Today’s announced settlement and the schemes described in the DOJ press release are ironic considering they were committed by an iconic South Florida institution under the leadership of the former Secretary of Health and Human Services, the very agency that promulgated the Medicare rules that were violated.”
Former congresswoman, UM President and HHS secretary Donna Shalala has not commented on the matter and was not named as a defendant in the case.