NEW HAVEN, Conn.-Yale University dodged one federal probe, but it did not escape another.
Yale has agreed to pay $5.5 million to settle an investigation into how its medical school handled two decades' worth of medical billings, the university said in a statement last week.
HHS' inspector general's office said late last year that a Physicians at Teaching Hospitals audit found no evidence that Yale was double billing for Medicare services rendered by residents (Oct. 27, 1997, p. 12).
PATH, an ongoing nationwide federal fraud probe, looks at how teaching hospitals bill Medicare for certain services.
The PATH audit of Yale and its 757-bed Yale-New Haven (Conn.) Hospital began in August 1996. It was unclear at deadline whether the billing investigation began at the same time. The school voluntarily began a billing compliance program in 1997.
Yale's latest encounter with federal investigators involves unresolved credit balances that had accrued over two decades preceding the school's computer conversion in 1995. Some of those balances had been written off.
The credit balances include accounting entries for whole and partial payments to the medical school that Yale could not match against any outstanding charges for patient care, the school's statement said.
In many cases, the match could not be made because the billing information was "erroneous or incomplete," Yale said. Other cases involved excess amounts from duplicate payments from payers.
Faulty administrative and inadequate computer systems caused the problems, Yale said.
Yale will refund more than $500,000 to the federal government, make a settlement payment of $700,000 and set aside another $4.3 million to repay Medicare carriers and other parties.
Yale also agreed to meet for four years deadlines for resolving existing and future credit balances from its billings.
The school will also maintain for that four-year period the medical billing compliance program it voluntarily implemented in 1997.
Yale also said it planned to invest up to $15 million in a state-of-the-art computer billing and information system to avoid such problems in the future.
Yale did not admit to any wrongdoing or liability.