MGH doctors agree to reimburse state Medicaid for over-billing By Associated Press, 7/24/2002 15:52

BOSTON (AP) Massachusetts General Hospital's anesthesia group has agreed to pay the state's Medicaid program more than $1.5 million to resolve an over-billing investigation, according to attorney general Tom Reilly.

A year-long investigation by the attorney general's office revealed that the state Division of Medical Assistance had overpaid the Massachusetts General Hospital Anesthesia Associates between September 1997 and June 2001 due to faulty billing practices.

Of the total payment, $1.23 million is for over-billing, $289,500 in penalties, and $10,000 in investigation costs.

According to the attorney general's office, between September 1997 and January 1999, the physician group charged the state's Medicaid program for every minute anesthesia was administered rather than following a formula dictated by the public assistance program.

After fixing that problem, the group started adding to its bill anesthesia charges that Medicaid also automatically tacked on, leading to double-billing. This occurred from February 1999 to June 2001.

The attorney general's office said that the group was notified of this double-billing twice in 2000 by an outside billing consultant, but did not tell Medicaid.

An MGH spokeswoman did not immediately return calls for comment. The anesthesia group is affiliated with Massachusetts General Physicians Organization Inc., which is owned and operated by the Partners HealthCare System Inc.

A Partners representative referred calls to MGH.

http://www.boston.com/dailynews/205/economy/MGH_doctors_agree_to_reimburse:.shtml

-- Anonymous, July 24, 2002

Answers

MDs to pay $1.5m in overbilling

Penalty included in Medicaid case

By Liz Kowalczyk, Globe Staff, 7/25/2002

Massachusetts General Hospital physicians will pay the state $1.5 million for overbilling the Medicaid program for anesthesia services and then failing to alert the agency immediately to the mistake, Attorney General Thomas F. Reilly's office said yesterday.

Reilly's Medicaid Fraud Control Unit and Massachusetts General Hospital Anesthesia Associates agreed on the settlement yesterday, following a yearlong investigation by the fraud unit. The physicians' group overbilled Medicaid from September 1997 to June 2001, said the unit's chief, Nicholas Messuri.

The doctors overbilled Medicaid in two ways, he said. They billed for anesthesia services by the minute, rather than for 15-minute units as required by state regulations. The group also double-billed Medicaid by tacking on charges that were supposed to be included in the agency's payments, Messuri said.

He said, however, that his unit did not find any evidence the group intentionally overbilled Medicaid. But Messuri said the physicians' group failed to notify Medicaid immediately when they discovered the overpayments - even though in one instance a consultant pointed out overbilling in a report two years ago.

Of the $1.5 million settlement, $1.2 million was to repay Medicaid for payments the physicians should not have received, and the remainder was for penalties.

''The case is really about corporate responsibility,'' Messuri said. ''It illustrates that an institution with as good a reputation as MGH still didn't have the safeguards to ensure Medicaid didn't get overbilled.''

Hospital executives said a computer error caused the overbilling. About 130 anesthesiologists work for Anesthesia Associates, part of the Massachusetts General Physicians Organization, which does the group's billing. The physicians' organization is headed by Dr. Peter Slavin, who in January will become president of Mass. General.

''We had a computer system that had been in place many years,'' said Jim Heffernan, chief financial officer of the physicians' organizaton. In the case of the 15-minute units, a computer programmer saw the error and fixed it in 1999, but did not assume Medicaid should be notified and repaid. In the case of the double-billing, executives did not see the problem listed in two thick consultants' reports. He said they saw it several weeks ago and alerted state officials. Messuri said the fraud unit will review anesthesia billing at other hospitals. He said Mass. General has agreed to adopt stricter procedures to ensure Medicaid is not overbilled.

Boston Globe

-- Anonymous, July 26, 2002