Medical College pays $840,000 to settle alleged false claims

The Medical College of Wisconsin Inc. has paid the federal government $840,000 to resolve allegations that it violated the False Claims Act, according to an announcement made by United States Attorney James Santelle of the Eastern District of Wisconsin.

MCW is alleged to have knowingly billed federal health care programs for neurosurgeries involving residents who did not receive the required level of supervision from teaching physicians.

The civil settlement resolves a lawsuit filed under the qui tam—or whistleblower—provisions of the False Claims Act, which allows private citizens with knowledge of fraud to bring a civil action on behalf the United States and share in any recovery. As part of the resolution, the whistleblower will receive a share of the settlement.

The qui tam complaint alleged that MCW submitted false claims to the Medicare and TRICARE programs for teaching physicians’ services in performing neurosurgeries involving residents. If a resident helps perform a surgery, Medicare will pay for a teaching physician’s services only if he was present for the surgery’s key parts and either remained immediately available throughout the surgery or else arranged for a back-up surgeon to be available.

MCW allegedly billed for teaching physicians’ services even though they were responsible for multiple overlapping surgeries and did not satisfy those supervision requirements. The settlement resolves certain claims submitted between April 16, 2006, and March 31, 2013. MCW denied the allegations.

“The settlement we are announcing today reflects the focused, sustained and purposeful efforts of the Justice Department, together with our partnered federal agencies, to investigate and redress fraud in our health care system,” Santelle said. “Under the authority of the False Claims Act, we are aggressive yet even-handed in pursuing health care fraud to ensure that taxpayer dollars are spent lawfully and that federal monies that should not have been paid are returned with an appropriate penalty.”

The FBI, the Office of Inspector General for the U.S. Department of Health & Human Services, and the U.S. Department of Defense were involved in the investigation. The case was handled by assistant United States attorney Matthew Krueger.

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