United States Attorney's Office District of Connecticut
Press Release

YALE-NEW HAVEN HOSPITAL ENTERS INTO $3.7 MILLION FEDERAL CIVIL SETTLEMENT AGREEMENT

Kevin J. O’Connor, United States Attorney for the District of Connecticut, today announced that YALE-NEW HAVEN HOSPITAL, located at 20 York Street, New Haven, Connecticut has entered into a civil settlement agreement with the Government in which it will pay $3,777,861 to resolve allegations that it violated the False Claims Act.

U.S. Attorney O’Connor explained that the allegations against YALE-NEW HAVEN HOSPITAL involved charges to Medicare for infusion therapy, chemotherapy administration and blood transfusion services.  During the time-period at issue, Medicare only allowed payment for one unit of infusion therapy and chemotherapy administration per patient visit, and one unit of blood transfusion services per day.  However, on many occasions, YALE-NEW HAVEN HOSPITAL billed Medicare for multiple units of these services.  Instead of billing for one unit per patient visit or one unit per day, YALE-NEW HAVEN HOSPITAL often billed Medicare for between two and five units.

The allegations also involved claims for services provided in YALE-NEW HAVEN HOSPITAL’S Oncology Infusion Service that were not adequately documented in the patients’ medical record, including dispensing medication and conducting laboratory studies without written orders signed by a physician.  This conduct was disclosed by YALE-NEW HAVEN HOSPITAL to the Government pursuant to the Provider Self-Disclosure Protocol (the Protocol), issued by the Office of Inspector General (OIG), United States Department of Health and Human Services.  Under the Protocol, the OIG encourages health care providers to voluntarily disclose matters that may constitute violations of federal criminal, civil or administrative law.

The improper conduct in question occurred between 2000 and 2005.  In order to resolve potential liability under the False Claims Act, YALE-NEW HAVEN HOSPITAL agreed to pay the Government a total of $3,777,861.00.  The False Claims Act provides for treble damages and penalties of $5,500 to $11,000 per false claim submitted to the Government.

YALE-NEW HAVEN HOSPITAL fully cooperated with the Government in its investigation of this case.

“The health care system relies on hospitals to bill Medicare honestly and accurately,” U.S. Attorney O’Connor stated.  “Billing Medicare for inflated charges relating to chemotherapy services and blood transfusion services damages the fiscal integrity of the Medicare program.  In addition, relevant regulations require hospitals to properly document a physician’s orders for medication and laboratory studies.”

In entering into the civil settlement agreement, YALE-NEW HAVEN HOSPITAL did not admit liability and the agreement indicates that the parties entered into the settlement to avoid the uncertainty and expense of litigation.

This case was investigated by the Office of Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation, and was prosecuted by Assistant United States Attorney Richard M. Molot, along with Auditor Kevin Saunders.

People who suspect health care fraud are encouraged to report it by calling the Health Care Fraud Task Force at (203) 785-9270 or 1-800-HHS-TIPS.

CONTACT:

U.S. ATTORNEY'S OFFICE
Tom Carson
(203) 821-3722
thomas.carson@usdoj.gov