University of Maryland Shore Regional Health has resolved the lawsuit of overcharging Maryland Medicaid and Medicare programs by paying $9.5 million to the federal and state government.
In June 2016, the lawsuit came up when the whistleblower brought forward claims that Shore Health purposely overcharged the healthcare programs for the services they provide to their beneficiaries. As per the False Claims Act, private citizens can file lawsuits on the government's behalf for fraudulent payment claims under government programs.
Shore Regional Health provides medical healthcare services in its two hospitals situated in the Eastern Shore to patients covered under Medicare or Medicaid programs.
Trena Williamson, the representative from the University of Maryland Shore Regional Health, said in a statement after the settlement that they always commit to having their billing practice in compliance with state and federal requirements. Apart from the $9.5 million to the federal and state government, they have also borne charges for legal costs associated with the matter.
The original complaint accuses the healthcare body of improperly billing the Medicare program since June 2014 for outpatient services by using a provider transaction access number (PTAN) at unregulated facilities.
The Maryland Health Services Cost Review Commission (HSCRC) fixes the sum Medicare pays with the reimbursement rates for outpatient services at regulated facilities. The HSCRC does not decide the charges for services provided at unregulated healthcare centers.
The Maryland U.S. Attorney's Office and the State of Maryland came to the $9.5 million settlement with UM Shore Regional Health in June 2021, which UM Shore Regional Health deliberately paid. The healthcare system didn't concede obligation for the over-charging in the settlement.