A New Jersey-based healthcare consulting firm has agreed to pay $2.9 million to settle allegations that it advised clients to adopt charge structures that manipulated Medicares outlier program.
Following the lead of whistle-blower lawsuits filed in 2002 and 2005, which remain under seal, the U.S. Justice Department alleged that Besler Consulting, North Brunswick, N.J., violated the False Claims Act by encouraging clients to inflate charges to the point that they no longer reasonably reflected or approximated costs, thereby squeezing bigger returns in Medicare outlier payments, according to the agreement.
The settlement is the first time the government has named a consulting firm as a target in its multiyear investigation of alleged outlier abuse. The matter has yielded several settlements with hospitals and health systems, such as Tenet Healthcare Corp., Dallas, and St. Barnabas Health Care System, West Orange, N.J.
Philip Besler, the firms president, adamantly denies any wrongdoing and said he agreed to the settlement because the payment is less than it would cost to keep fighting. Weve been talking to (government officials) for three years and they still have not told us what an unreasonable charge is, Besler said. Part of the firms service, Besler said, was to provide a national database of hospital charges that allowed clients to adjust their own structure and maximize reimbursement, which was then vetted by lawyers. All my clients did was raise charges across the board; that affected all payers in some way. -- by Gregg Blesch