Lawsuit deal to cost UF $8.6-million

The settlement would end litigation that started when a whistle-blower accused the university of overbilling Medicare.

By BARRY KLEIN

© St. Petersburg Times,
published August 14, 2001

The University of Florida is prepared to pay $8.6-million to settle allegations that its doctors overbilled the government when filing Medicare claims from 1987 to 1997.

If all parties sign off, the settlement would end eight years of litigation that began with a whistle-blower's accusations. The agreement requires UF to pay $6.8-million to the federal government and $1.8-million to Florida's Agency for Health Care Administration.

The federal investigation began in 1993 when Robert Mames, an ophthalmologist, alleged that faculty doctors at UF's College of Medicine were improperly billing Medicare for care that was provided by lesser-skilled resident physicians. Mames alleged that faculty physicians were not present when residents performed the services.

A second whistle-blower raised separate allegations about billing for clinical pathology work at the college. Investigators also looked into allegations that other health care agencies, including the Department of Veterans Affairs, were overbilled by faculty physicians.

The proposed settlement says the university "does not possess sufficient documentary evidence" to show that the doctors who billed for services "were personally and identifiably involved in the performance of those services."

As part of the proposed settlement, UF has agreed to a "compliance agreement" to ensure that overbilling and other problems don't occur in the future.

UF attorney Pam Bernard said Monday that she could not comment on the proposed settlement, which includes no admission of fault or liability on the university's part. A spokesman for the state Attorney General's Office declined to comment.

Mames, the former UF ophthalmologist who initiated the federal investigation, did not return phone calls. As a whistle-blower, Mames could receive a portion of the settlement.

The $8.6-million would not come from taxpayers. It would be paid by the Florida Clinical Practice Association, which administers the medical school's physician's pay plan.

Its revenues are generated from fees charged by UF doctors. That includes faculty physicians who supervise medical students but who are supposed to render patient care when they submit claims to Medicare.

If the settlement goes forward, UF will join several other universities that have paid the government millions of dollars in recent years after being accused of violating Medicare guidelines.

The University of Pennsylvania paid the stiffest price when officials agreed in 1995 to pay $30-million to settle allegations that its doctors had submitted $10-million in false Medicare claims from 1989 to 1994.

The University of California settled a civil action this year for $22.5-million. UC officials said it was cheaper to settle than to fight. Litigation costs, they said, were approaching $15-million.

There was no way to determine Monday how much UF has spent on legal bills.

But in 1997, then-President John Lombardi complained that the university had spent more than $1-million.

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