Boston Medical Center (BMC) and its community health center, East Boston Neighborhood Health Center (EBNHC) agreed to pay $600,000 to resolve whistleblower’s allegations that the defendants submitted inappropriate charges to the Massachusetts Uncompensated Care Pool for emergency services performed at the health center. BMC and EBNHC also agreed to enter into discussions with the Massachusetts Department of Public Health regarding the standards for operation in the Urgent Care Department of EBNHC.
The Massachusetts Uncompensated Care Pool, then known as the Health Safety Net Trust Fund, and commonly referred to as the “Free Care Pool”, provided reimbursement to acute care hospitals and community health centers for medically necessary services provided to low-income, uninsured and underinsured residents of Massachusetts. The Free Care Pool was funded in part by the federal and state governments.
The whistleblower alleged that defendants overcharged the government for services provided to patients seen in the Urgent Care Department of EBNHC. The alleged overcharges submitted to the Free Care Pool were designed to compensate health care providers that are usually not open after 10:00 p.m. on Sundays, holidays, or for emergencies. However, the Urgent Care Department was open for urgent care and emergencies 24 hours a day, 7 days a week. By submitting these charges, authorities alleged that EBNHC increased its overall reimbursement from the Uncompensated Care Pool during the fiscal years of 2003 to 2006.