Baptist Health Systems of San Antonio has paid more than $3.5 million to settle claims that it filed false claims for reimbursement under Medicare, 1200 WOAI news reports.
U.S. Attorney Robert Pitman says the Baptist would bill Medicare for patient treatment, without notifying Medicare that the patient had another insurance policy that covered the care at Baptist.
Medicare requires providers to disclose the fact that a patient has other insurance when it files its claim with Medicare. In those cases, Medicare pays the deductable, and the private insurance pays the bulk of the claim.
"If the health care provider receives a double payment because the insurance company is slow to pay, then the health care provider must reimburse Medicare," Pitman said.
Pitman says Baptist Health Systems cooperated with the investigation, and conducted an audit of all claims to Medicare dating back to 2003. Officials say the Baptist is no longer engaging in the activity.
A whistleblower who told the feds about the fraud is also receiving a generous payday. Norma Rivera gets $506,000 as her share of the settlement, and the Baptist was required to pay Rivera's attorneys fees and expenses.