April 26, 2011

Masonicare Pays Hefty Settlement

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The Masonicare Health Center of Wallingford has agreed to pay a civil settlement of $447,776 to resolve allegations that it violated the False Claims Act, according to the U.S. attorney’s office.

In a press release, U.S. Attorney David B. Fein said the allegations against Masonicare Health Center involved improper billing to Medicare and Medicaid for injections of leuprolide acetate (known by the brand name Lupron or Lupron Depot).The drug is used to treat prostate cancer in men, and endometriosis and fibroids in women. The dosage for treatment is different for men and women, and the reimbursement rate for treating female patients is higher.

The government alleges that Masonicare:
• Regularly used the female billing code when treating male patients with Lupron for cancer;
•  Received substantially higher reimbursements from Medicare and Medicare;
• Discovered in 2009 that it had improperly billed, but did nothing to pay the money back to the government health insurance programs.

The settlement covers reimbursement to Medicare and Medicaid programs from Jan. 1, 2001 to May 31, 2010.  Masonicare, an in-and-out patient facility that treats many seniors, did not admit liability in agreeing to the settlement.

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