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Hospital Upcoded Lupron Injections By Billing Male Patients as Females

April 29, 2011

Lupron or Lupron Depot (leuprolide acetate) is a drug injected into men to treat prostate cancer, but it can also be used to treat endometriosis and fibroids in women.  The drug is covered by Medicare and Medicaid, but the injection for women warrants a higher reimbursement than when it is used to treat men.  In order to maximize reimbursments, at least one Connecticut hospital apparently decided to code all of its injections as if they were for women even when they were actually for men.  Masonicare Health Center in Connecticut will pay nearly half a million dollars to settle False Claims Act allegations that it upcoded its Lupron injections for almost a decade.

To report upcoding or other False Claims Act violations, contact Frohsin & Barger.

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