Jackson Memorial Health System, the Miami-based parent company of 1,776-bed Jackson Memorial Hospital, becomes the sixth hospital client of Healthcare Financial Advisors to settle Medicare cost reporting fraud allegations with the U.S. attorney in Los Angeles, agreeing to pay $14.25 million to settle a 1998 whistle-blower lawsuit. Government prosecutors and whistle-blower Mark Razin, a former reimbursement specialist with HFA, allege that HFA helped the public hospital system and other hospital clients defraud Medicare and Medicaid by seeking and obtaining reimbursements for unallowable costs on reopened cost reports, and allegedly concealing those wrongful overpayments from the government. Some of those overpayments date back to 1987. HFA, now part of Cupertino, Calif.-based Certus Software, was a revenue recovery firm that would reopen closed Medicare cost reports and was paid by hospitals on a contingency fee basis from any reimbursements they uncovered. To date, the investigation has implicated more than 20 hospitals and recovered $50 million for government health insurance programs. Jackson Memorial, overseen by the Public Health Trust of Dade County, settled without admitting wrongdoing. In a news release Jackson Memorial officials said: These discrepancies occurred long before the current administration was in place at Jackson Health System. We look forward to working with the U.S. government to ensure compliance on all future billings.
Calls to Certus Software seeking comment were not returned at deadline. -- by Mark Taylor