Christus Spohn Health System Corp., a Texas-based hospital system, has paid $5 million to settle a false claims lawsuit. The settlement involved alleged violations of the False Claims Act, according to U.S. Attorney Kenneth Magidson. The allegations included inappropriately admitting patients to “inpatient status” for “outpatient procedures.” The settlement resolves allegations that six Christus Spohn hospitals in and around Corpus Christi, Texas, submitted false claims to the Medicare program by using “inpatient codes” for procedures that should have been billed under an “outpatient code.” Inpatient codes allow the hospitals to collect more money from the Medicare program than they would have using outpatient codes.
The six hospitals included Christus Spohn Hospitals in Corpus Christi – Shoreline, Corpus Christi – Memorial, Corpus Christi – South, Alice, Beeville and Kleberg. The investigation leading to the settlement began in March 2008 after Christus – Shoreline’s former director of case management filed a lawsuit under seal under the qui tam provisions of the False Claims Act alleging the six hospitals were submitting false claims to the Medicare program by billing for services that should have been performed on an outpatient basis as if they were more expensive inpatient services.
It was alleged that these hospitals were routinely billing outpatient surgical procedures as if they required an inpatient level of care, which greatly increased the amounts paid to these hospitals by the Medicare program. These patients were often discharged from the hospital in less than 24 hours. The investigation was conducted by the Department of Health and Human Services – Office of Inspector General. Assistant United States Attorney Andrew A. Bobb managed the investigation and conducted the settlement negotiations.
Source: Insurance Journal
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