March 19, 2010 — Robert Wood Johnson University Hospital Hamilton

Robert Wood Johnson University Hospital Hamilton, a New Jersey-based hospital, has agreed to pay $6.35 Million to settle claims it defrauded Medicare and TRICARE.

The allegations of the case were that the Hospital falsely inflated charges to obtain additional “outlier payments.”

In addition to its standard payment system, Medicaid provides supplemental reimbursement, called “outlier payments,” to hospitals and other health care providers in cases where the cost of care is unusually high.

Congress enacted supplemental outlier payments system to ensure that hospitals have the incentive to treat inpatients whose care requires unusually high costs.

Several private relators filed claims asserting that the hospital inflated its charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid.

As a reward, the private relators will receive $1.1 Million from the settlement.

See U.S. Dept of Justice Press Release 03/19/10

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