On Wednesday, November 1, 2017, it was announced that Mercy Hospital of Portland had entered into a civil settlement agreement with the United States and Maine. As a part of that agreement, Mercy will pay $1,514,000 to resolve allegations that it violated the federal and Maine False Claims Acts. The settlement resolves allegations that MaineCare and Medicare were overbilled for urinalysis drug screen tests that were ordered and performed at the former Mercy Recovery Center in Westbrook.
These tests were performed from 2011 to 2013. In October of 2013, Eastern Maine Healthcare Systems acquired Mercy and its affiliate, Mercy Recovery Center. It was alleged that Mercy falsely utilized a billing modifier code to receive payment for multiple same-day urinalysis drug screen tests, which did not arise from separate or medically necessary encounters with the same patients on the same days.
These tests should have been bundled and billed as a single claim for each encounter. However, Mercy allegedly billed for the tests on a per-test basis. In return, this caused MaineCare and Medicare to overpay Mercy on multiple claims. Mercy cooperated with the investigation. Subsequently, Mercy and Eastern Maine Healthcare Systems integrated improved internal compliance measures to prevent future overbilling issues.
