Thirty-two hospitals in 15 states, including the Cleveland Clinic and hospitals associated with the Community Health Systems, Tenet and Banner Health, are on the hook for $28 million to settle allegations they submitted false claims for inpatient care to perform minimally-invasive spinal surgery that could have been done in a less expensive outpatient setting, according to the U.S. Justice Department.
The settlements resolve allegations that the 32 hospitals frequently billed Medicare for kyphoplasty procedures on a more costly inpatient basis to increase their Medicare billings, the Justice Department said.
Kyphoplasty is used to treat certain spinal fractures that are often due to osteoporosis. In many cases, the procedure can be performed safely and effectively as an outpatient procedure, the Justice Department said.
[Also: 457 hospitals settle for $250 million over improper implantable cardioverter defibrillator surgeries]
With Friday's announcement, the government has reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations they mischarged Medicare for kyphoplasty procedures.
In addition, the government previously settled with Medtronic Spine, the corporate successor to Kyphon.
The company paid $75 million to settle allegations it caused false claims to be submitted to Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures.
All but three of the settling facilities announced today were named as defendants in a whistleblower lawsuit by citizens who will receive a portion of the proceeds of the settlement.
[Also: Novartis to pay $370 million to settle claims it paid kickbacks for drug referrals]
The lawsuit was filed in federal district court in Buffalo, New York, by Craig Patrick and Charles Bates. Patrick is a former reimbursement manager for Kyphon, and Bates was formerly a regional sales manager for Kyphon in Birmingham.
The whistleblowers will receive a total of approximately $4.75 million from the settlements.
The 32 settling facilities and the amounts they have agreed to pay are: the Cleveland Clinic in Cleveland, Ohio, $1.74 million; Citrus Memorial Health System in Inverness, Florida, $2.6 million; Cullman Regional Medical Center in Cullman, Alabama, $350,000; Martin Memorial Medical Center in Stuart, Florida, $2 million;;MultiCare Tacoma General Hospital in Tacoma, Washington, $983,000; Norwalk Hospital in Norwalk, Connecticut, $920,000; Princeton Community Hospital Association in Princeton, West Virginia, $1.5 million; Sacred Heart Medical Center in Spokane, Washington, $906,000; Sarasota Memorial Hospital in Sarasota, Florida, $972,000; Spartanburg Regional Health Services District Inc. in Spartanburg, South Carolina, $1.7 million; St. Cloud Hospital in St. Cloud, Minnesota, $500,000; and Tampa General Hospital in Tampa, Florida, $2 million.
Five hospitals affiliated with Community Health Systems Inc., in Franklin, Tennessee have agreed to pay $3.5 million.
These include: Crestwood Medical Center in Huntsville, Alabama; St. Joseph's Hospital in Fort Wayne, Indiana; Carolinas Hospital System in Florence, South Carolina; Mary Black Health System in Spartanburg, South Carolina; and Trinity Medical Center in Birmingham, Alabama.
Also among those settling are five hospitals affiliated with Tenet Health Care Corporation in Dallas, Texas, that have agreed to pay $2.2 million. These include: East Cooper Medical Center in Mt. Pleasant, South Carolina; North Fulton Hospital in Roswell, Georgia; Providence Memorial Hospital in El Paso, Texas; St. Francis Hospital in Memphis, Tennessee; and Sierra Medical Center in El Paso.
Five hospitals formerly owned and operated by Health Management Associates Inc., in Naples, Florida, have agreed to pay a total of $2 million. These include: Biloxi Regional Medical Center in Biloxi, Mississippi; Davis Regional Medical Center in Statesville, North Carolina; Lancaster Regional Medical Center in Lancaster, Pennsylvania; Physicians Regional Medical Center in Naples, Florida; and Riley Hospital in Meridian, Mississippi.
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Three hospitals affiliated with BayCare Health System in Clearwater, Florida, have agreed to pay a total of $1.5 million. They are: Winter Haven Hospital in Winter Haven, Florida; St. Joseph's Hospital in Tampa, Florida; and St. Anthony's Hospital in St. Petersburg, Florida.
Two hospitals affiliated with Banner Health in Phoenix, Arizona, have agreed to pay a total of $2.685 million. These include Banner Boswell Medical Center in Sun City, Arizona, and Banner Thunderbird Medical Center in Glendale, Arizona.
"Charging the government for higher cost inpatient services that patients do not need wastes the country's vital health care dollars," said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department's Civil Division. "The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire to maximize hospital profits."
Twitter: @SusanJMorse