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United Memorial Medical Center Agreed to Be Excluded for 10 Years for Allegedly Submitting False Claims for Inpatient Cost Outlier Payments and Duplicate Claims for COVID-19 Tests

On December 14, 2023, in connection with the resolution of their False Claims Act liability, Doctors Hospital 1997 L.P., d/b/a United Memorial Medical Center LLC (UMMC), Houston, Texas, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for 10 years. The investigation revealed and OIG alleged that UMMC: (1) submitted or caused to be submitted false claims to the Medicare and TRICARE programs for inpatient cost outlier payments by rapidly increasing its charges for inpatient care and significantly underreporting its charges on Medicare cost reports such that, when adjusted to cost pursuant to the cost outlier statute and regulations, these charges no longer reasonably reflected or approximated UMMC’s actual costs; (2) concealed and improperly avoided its obligations to adequately reimburse the Medicare and TRICARE programs for any excessive cost outlier payments that it received; and (3) submitted false claims to HRSA’s COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program for COVID-19 testing services rendered to patients, submitted duplicate claims to the state of Texas and/or city of Houston for those same COVID-19 tests, additionally received reimbursement from the state of Texas and/or city of Houston for those testing services for which UMMC requested payment from the Uninsured Program, and failed to return to HHS those duplicate payments. Senior Counsel Ellen Slavin represented OIG.

Action Details

  • Date:December 14, 2023
  • Enforcement Types:
    • CMP and Affirmative Exclusions,
    • COVID-19