15 Biggest Hospital False Claims and Anti-Kickback Stories of 2011

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http://www.beckershospitalreview.com/stark-act-/-antikickback-statute-/-false-claims/15-biggest-hospital-false-claims-and-anti-kickback-stories-of-2011.html

Written by Jaimie Oh | September 20, 2011

1. In January, seven hospitals agreed to pay the United States more than $6.3 million to settle allegations that they submitted false claims to Medicare related to kyphoplasty procedures, a minimally invasive procedure used to treat certain spinal fractures in an inpatient setting, to increase Medicare billings, instead of using less-costly outpatient facilities that are just as safe in many cases. The procedures were allegedly performed from 2000-2008. Lakeland (Fla.) Regional Medical Center agreed to pay the most at $1.66 million. The other six hospitals that have agreed to settle the allegations include the Health Care Authority of Morgan County in Decatur, Ala. ($537,892); St. Dominic-Jackson (Miss.) Memorial Hospital ($555,949); Seton Medical Center in Austin, Texas ($1,232,955); Greenville (S.C.) Memorial Hospital ($1,026,764); Presbyterian Orthopaedic Hospital in Charlotte, N.C. ($637,872); and the Health Care Authority of Lauderdale County and the City of Florence, Ala. ($676,038).

2. Detroit Medical Center announced in January it would pay $30 million to the federal government to settle findings from an internal investigation that uncovered potentially improper relationships between the health system and more than 250 physicians. DMC voluntarily disclosed the findings from its investigation, which included leases that were not at fair market value, free advertising and tickets to events and seminars from 2004-2010. The investigation was conducted before DMC's sale to Vanguard Health Systems last year.

3. Savannah, Ga.-based St. Joseph's/Candler Health System agreed in February to pay the state of Georgia $2.717 million in a civil settlement over Medicaid billing for inpatient and outpatient services at its two Savannah-area hospitals. The settlement follows an 11-month investigation that found SJCHS filed claims that were short of the full amount of Medicare prior payments, allowing the system to receive excessive reimbursement. SJCHS also agreed to pay an additional $2,500 to defray the costs of the investigation. The system implemented corrective actions to ensure that similar billing problems do not reoccur.

4. Catholic Healthcare West agreed in February to pay $9.1 million to settle allegations that seven CHW hospitals submitted false Medicare claims. The settlement resolves allegations that three hospitals that received overpayments did not return the funds when Medicare processing errors were discovered; three CHW hospitals submitted inflated costs for their home health agencies and were overpaid; and one hospital was overpaid for treating a high percentage of patients with end-stage kidney disease for several years, including two years when the hospital was not eligible. CHW acknowledged the errors and "is pleased to have resolved this matter."