A Boston hospital that specializes in eye, ear, nose and throat ailments has agreed to pay $2.7 million to resolve federal fraud allegations, Acting U.S. Attorney for Massachusetts Nathaniel Mendell announced Tuesday.
Prosecutors say Massachusetts Eye and Ear improperly billed government health care programs for certain office visits, defrauding the country of more than a million dollars.
“When health care providers submit improper claims to Medicare and Medicaid, they do two bad things: they unjustly enrich themselves, and they drain money needed for legitimate patient care,” Mendell said. “This settlement punishes bad billing and helps safeguard government health care programs from fraud, waste and abuse.”
Prosecutors say from 2012 to early 2020, the Harvard Medical School-affiliated hospital regularly submitted claims to Medicare and Massachusetts’s Medicaid program for office visits at which physicians performed nasal endoscopies and laryngoscopies.
The government programs, however, do not permit billing for the office visits in addition to billing for the procedures themselves. Prosecutors contend Mass Eye and Ear therefore obtained reimbursements it wasn't entitled.
They say the allegations were originally brought in a lawsuit filed by a whistleblower. Mass Eye and Ear said in a statement that it's "taken corrective actions to address our billing processes.”