An example of how the taxpayers are being cheated relating to government programs involves a scheme by a number of hospitals to cheat the government in the Medicaid program. The federal government paid one of the hospitals, Saint Vincent Health Center, $6.15 million in the 2003 fiscal year to treat some of the Erie, Pennsylvania, hospital’s oldest, sickest patients. Now as a result of a recent settlement, Saint Vincent will have to pay $1.9 million to settle a whistle-blower lawsuit that claimed the hospital submitted Medicare claims that exceeded its actual costs.
A total of seven hospitals have reached settlements in connection with a lawsuit, which was filed in 2005, by Anthony Kite, an independent hospital consultant from New Jersey. Saint Vincent was inflating its Medicare reimbursement claims from 2001 to 2003 to receive supplemental, or outlier, payments. Outlier payments reimburse hospitals for treating patients who require more care than usual for a particular illness or procedure. In late 2002, Saint Vincent raised the average charge for many of its most common treatments and procedures between 40% and 120%, according to information provided by the Pennsylvania Health Care Cost Containment Council. Larry Zoglin, the lawyer who represented the whistleblower, had this to say:
Saint Vincent dramatically hiked its charges across the board in 2002. It allowed the hospital to send a higher percentage of claims to Medicare for outlier payments. These were normal-cost patients made to look like outlier patients.
Kite never worked as a consultant for Saint Vincent, but learned what the Erie hospital was doing while working with other hospitals named in the lawsuit. Saint Vincent received $6.15 million in outlier payments from Medicare in fiscal 2003, more than four times the $1.42 million it collected in fiscal 2002. This is an example of how some in Corporate America cheat the government when participating in good federal programs. The taxpayers foot the bill and program recipients are hurt because cheating the government takes money away from them.
Source: Erie Times News
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