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May 13, 2021

University of Miami To Pay $22 Million to Settle Claims Involving Medically Unnecessary Laboratory Tests and Fraudulent Billing Practices

On May 10, DOJ announced that the University of Miami (UM) has agreed to pay $22 million to settle allegations that UM knowingly engaged in improper billing relating to its hospital facilities, billed federal programs for medically unnecessary lab tests for patients who received kidney transplants, and caused Jackson Memorial Hospital (JMH) to submit inflated claims for reimbursement for pre-transplant testing. According to DOJ, when a patient checked into the Miami Transplant Institute (MTI), UM’s electronic system triggered a pre-set series of tests to be run for the patient at UM’s labs. DOJ alleged that several of these tests were medically unnecessary and used for financial considerations rather than patient care. Further, DOJ alleged that UM caused JMH to submit inflated claims for reimbursement for pre-transplant lab testing at MTI which was in violation of related party regulations which limit the reimbursement a provider can obtain for tests performed by a related entity to that entity’s actual costs. In a separate agreement, DOJ reached a $1.1 million settlement with JMH relating to this conduct.