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December 12, 2022

Saint Vincent Hospital to pay $1.8M for alleged violations of the False Claims Act

Photo | Grant Welker Saint Vincent Hospital in Worcester

Saint Vincent Hospital in Worcester will pay $1.784 million to resolve allegations it inflated charges to patients in 2018 and 2019 in order to receive outlier payments from Medicare, according to a Friday press release from the office of the U.S. Attorney’s Office, District of Massachusetts.

Saint Vincent Hospital admitted it increased its charges for inpatient services, including for a cardiac surgical procedure known as a Transcatheter Aortic Valve Replacement (TAVR) – once by 18%, and two more times by 15%, according to the press release. 

The increased charges resulted in a greater number of Medicare outlier payments, including cases where outlier payments were not appropriate because there were no unforeseen complications or extended lengths of stay that led to the extraordinarily high costs. 

The hospital made a voluntary payment to the Medicare Administrative Contractor prior to the settlement, but that payment did not cover all of the outlier payments that the hospital received.

Hospitals can submit claims for outlier payments when the hospital incurs unexpected expenses related to complications.

Shelly Weiss Friedberg, a spokesperson for Saint Vincent Hospital, issued a statement, "This settlement involves older claims relating to a technical Medicare billing issue for a minimally invasive procedure, transcatheter aortic valve replacement (TAVR), made available to the community as part of Saint Vincent Hospital’s cutting-edge cardiovascular program. The procedure requires the use of a unique device for which manufacturers charge the hospital more than $30,000 per patient. This resulted in a complicated charge structure for Medicare, however, this did not impact any Medicare patient’s out of pocket costs.

"As noted by the government in its press release, Saint Vincent Hospital had already identified the issue and started processing repayment of excess funds it received from Medicare before any contact by the government," Weiss Friedberg continued. "The Hospital fully cooperated with the government throughout the process and is pleased that this settlement fully resolved the issue. No concerns were raised regarding the quality of patient care provided and the hospital maintains a commitment to compliance."

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