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Ridgefield Doctor Pays $218K To Settle Medicare Dispute With Government

Dr. Edward Berman
Dr. Edward Berman Photo Credit: Danbury Hospital website

RIDGEFIELD, Conn. -- A Ridgefield doctor will pay over $218,000 to the federal government to resolve claims that he violated the False Claims Act through fraudulent Medicare billing, U.S. Attorney Deirdre Daly said Friday.

Dr. Edward Berman, who has a practice on Prospect Street in Ridgefield specializing in internal medicine and geriatric medicine, was accused of making fraudulent billing to Medicare for subsequent skilled nursing facility (“SNF”) services, Daly said.

The government alleges that Berman, who is affiliated with Danbury Hospital and Western Connecticut Health Network, submitted claims to Medicare for SNF services that were not performed in accordance with Medicare requirements, Daly said.

Specifically, the government said that Berman “upcoded” certain services, submitting claims to Medicare by using a higher-paying billing code when services with lower-paying billing codes were actually provided.

To resolve his liability under the False Claims Act, Berman will pay $218,633, in order to reimburse the Medicare programs for conduct occurring from Jan. 1, 2008, through March 4, 2014.

In entering into the settlement agreement, Berman did not admit liability.

“Health care providers that overcharge Medicare drain critical funds from the Medicare program and increase health care costs,” Daly said.  “The U.S. Attorney’s office is committed to vigorously pursuing physicians and other health care providers who submit fraudulent claims to federal health care programs.  Providers who submit false claims to the government face serious monetary and administrative sanctions.”

Under the False Claims Act, the government can recover up to three times its actual damages, plus penalties of $5,500 to $11,000 for each false claim.

This case was investigated by the Office of Inspector General for the Department of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Anne F. Thidemann with the assistance of Auditor Kevin A. Saunders.

Daly encouraged individuals who suspect health care fraud to report it by calling the Health Care Fraud Task Force at 203-785-9270 or 1-800-HHS-TIPS.

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