San Mateo County Medical Center and San Mateo County will collectively pay $11.4 million in settlement fees to resolve allegations related to "medically unnecessary inpatient admissions."
According to federal prosecutors, SMMC allegedly billed Medicare for non-covered inpatient hospital admissions from 2013 to 2017. The patients did not fall under Medicare because they were admitted for reasons that did not pertain to their diagnosis, including "social reasons and lack of available alternative placements," said a news release from the Department of Justice.
"The financial viability of our Medicare program must be protected for current and future generations," said U.S. Attorney Stephanie M. Hinds for the Northern District of California in a statement. "Medical providers, such as SMMC, who seek to pass on the financial burden of their medically unnecessary hospital admissions to the federal government will be pursued, as today's settlement reflects."
SMMC will now have to hire an independent review organization to analyze their inpatient admissions that are sent to Medicare every year for the next five years as a part of the settlement.
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"Our agency will continue to aggressively investigate health care providers who bill Medicare for medically unnecessary services. These unlawful actions divert funds for needed care," said Special Agent in Charge, Steven J. Ryan of the U.S. Department of Health and Human Services Office of Inspector General.
"Working with our law enforcement partners, we will continue to root out such schemes."
