$11M Settlement Agreed To By San Mateo Co. Over Medicare Misuse

SAN MATEO, CA — The San Mateo County Medical Center and San Mateo County (SMMC) agreed to an $11.4 million settlement with federal prosecutors over allegations of submitting Medicare claims for inpatient admissions that were “non-covered.”

Between 2013 and 2017, SMMC billed Medicare for admission of patients for whom inpatient care was “not medically reasonable or necessary” despite knowing that the costs were not reimbursable by Medicare, according to the Department of Justice in a news release Friday.

“Billing for non-covered hospital stays results in a misuse of federal dollars,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “Today’s settlement demonstrates our continuing commitment to ensure that Medicare pays only for services that are eligible for reimbursement.”

The settlement also requires that SMMC bring in an independent review organization to monitor inpatient admissions which the hospital decides to bill to federal health care programs.

“The financial viability of our Medicare program must be protected for current and future generations,” said Acting U.S. Attorney Stephanie M. Hinds for the Northern District of California. “Medical providers, such as SMMC, who seek to pass on the financial burden of their medically unnecessary hospital admissions to the federal government will be pursued, as today’s settlement reflects.”

View the full settlement agreement here.