Male v. Female Billing Error Results in Settlement

St. Francis Hospital and Medical Center has settled a False Claims Act complaint for $516,527 amidst claims that it overbilled Medicare for a prostate cancer treatment. The drug Lupron is an injectable that is used to treat prostate cancer in men, as well as endometriosis and fibroids in women. The treatment for males and females each have a separate billing code, with the treatment for women yielding a higher reimbursement rate.

The government alleges that from 2001-2009, the hospital billed for the female billing code in the treatment of males. The Department of Health and Human Services also alleges the hospital knew about the billing errors, but failed to report them or repay the excess reimbursements, which constitutes a violation of the False Claims Act. A hospital spokeswoman said that St. Francis settled to avoid litigation costs and said the error was a result of a “misinterpretation of billing requirements.”

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