Nine hospitals located in Alabama, Indiana, Florida, Michigan, South Carolina, New York and Minnesota have agreed to pay more than $9.4 million to settle allegations that the healthcare facilities submitted false claims to Medicare.
According to the Department of Justice, the settlements resolve allegations that the hospitals overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. In many cases, the procedure can be performed safely as a less costly outpatient procedure, but the government contends that the hospitals performed the procedure on an in-patient basis to increase Medicare billing.
The facilities and the amount to be paid:
- Ball Memorial Hospital, Muncie, Ind. ($1,995,431)
- Bethesda Memorial Hospital, Boynton Beach, Fla. ($356,079)
- Bloomington Hospital, Bloomington, Ind. ($1,443,848)
- Genesys Regional Medical Center, Grand Blanc, Mich. ($931,742)
- Huntsville Hospital, dba The Healthcare Authority of the City of Huntsville, Huntsville, Ala. ($1,992,756);
- Palmetto Health dba Palmetto Health Baptist Hospital, Columbia, S.C. ($1,861,083.14)
- St. Elizabeth Medical Center, Utica, N.Y. ($195,976)
- St. Mary's of Michigan Hospital, Saginaw, Mich. ($260,065.21)
- United Hospital, St. Paul, Minn. ($428,656).
"These hospitals put profits ahead of sound medical judgment," said Tony West, assistant attorney general for the Civil Division of the Department of Justice. "The Justice Department is committed to protecting Medicare funds from waste and abuse."
"It is critical that providers make patient admission decisions based on medical necessity and the level of care needed rather than on the Medicare payment they will receive," said Daniel R. Levinson, inspector general for the Department of Health and Human Services.
All but two of the facilities (St. Elizabeth Medical Center and United Hospital) were named as defendants in a lawsuit filed under the False Claims Act in 2008 in federal district court in Buffalo, N.Y., by Craig Patrick of Hudson, Wis. and Charles Bates of Birmingham, Ala.
The qui tam, or whistleblower, provisions of the False Claims Act permit private citizens, called relators, to file an action on behalf of the United States and share in any recovery. Patrick is a former reimbursement manager for Kyphon, and Bates is a former regional sales manager for Kyphon. The two will receive a total of approximately $1.5 million as their share of the settlement.