14 hospitals to pay $12M over false surgical claims

Fourteen hospitals across the country will be shelling out a combined $12 million to settle allegations that they submitted false claims to Medicare, involving spinal fractures procedures, the U.S. Department of Justice said yesterday.

Four Florida hospitals under Adventist Health System/Sunbelt Inc. will pay a total of $3.9 million.

 

Hospital

Settlement

Plainview (N.Y.) Hospital

$2.3 million

North Shore Syosset (N.Y.) Hospital

$192,735

North Mississippi Medical Center in Tupelo, Miss.

$1.9 million

Mission Hospital in Asheville, N.C.

$1.5 million

Wenatchee (Wash.) Valley Medical Center

$1.2 million

Community Hospital Anderson (Ind.)

$500,561

St. John's Mercy Hospital in Creve Coeur, Mo.

$365,000

Gulf Coast Hospital in Fort Myers, Fla.

$173,005

Lee Memorial Hospital in Fort Myers, Fla.

$159,571

Cape Coral Hospital in Cape Coral, Fla.

$73,279

Florida Hospital Orlando

$3.9 million

Florida Hospital-Oceanside

Florida Hospital Fish Memorial

Florida Hospital Heartland Medical Center


The Justice Department alleged that hospitals in New York, Mississippi, North Carolina, Washington, Indiana, Missouri and Florida overbilled Medicare between 2000 and 2008 when performing kyphoplasties, procedures used to treat certain spinal fractures often due to osteoporosis, on an inpatient basis rather than the less-costly outpatient basis to reap the reimbursements.

"These hospitals put profits ahead of sound medical judgment, making decisions based on a desire to maximize Medicare reimbursement rather than on individualized assessments of medical necessity," said William J. Hochul Jr., U.S. Attorney for the Western District of New York in Buffalo.

The Justice Department has crack downed on false claims and reached settlements with more than 40 hospitals totaling more than $39 million related to kyphoplasty Medicare claims.

"Patients want reassurance that their health care provider is making treatment decisions based on the patient's best interests, not an interest in maximizing profits," Assistant Attorney General for the Justice Department's Civil Division Tony West said. "By recovering taxpayer dollars lost to improper billing, this settlement will help support the vital public health care programs we depend on."

For more information:
- read the DoJ statement
- read the AP article
- read the Bloomberg article

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