Poughkeepsie, N.Y.-based Hudson Valley Hematology Oncology Associates entered into a $5.3 million settlement to resolve claims that the company routinely waived copayments without lawful basis and fraudulently billed Medicare for those copayments, according to the Department of Justice.
The complaint was initially filed under the qui tam provision of the False Claims Act. It alleged HudsonValley engaged in two false and fraudulent schemes to defraud the government from 2010 through 2015, including billing for services that were not medically necessary or not performed and routinely waiving beneficiaries' co-payments and billing the co-payments to Medicare.
As part of the settlement, Hudson Valley admitted, acknowledged and accepted responsibility for engaging in certain conduct during the time frame, including: routinely waiving Medicare beneficiaries' co-payments without an individualized documented determination of financial hardship, billing Medicare for the waived copayments and overbilling Medicaid and Medicare for evaluation and management services codes, in addition to billing for routine procedures without providing proper documentation of those services, among other claims.
In addition to the government settlement, HudsonValley also entered into a corporate integrity agreement with HHS, under which the company committed to establishing a compliance program and taking further steps to ensure future compliance with CMS rules.
United States District Judge Kenneth Karas approved the settlement agreement Oct. 19.