Hospital False Claims settlement shows value of self-monitoring, voluntary disclosure

Our Lady of Lourdes Memorial Hospital in Binghamton, New York, paid more than $3 million to resolve False Claims Act liability stemming from its Medicare billing, the U.S. Attorney's office for the Northern District of New York announced.

The 242-bed Catholic hospital improperly filed claims for services rendered at its hyperbaric oxygen therapy facility, treating it as "provider-based" even though it didn't meet Medicare requirements for that designation, according to a Press & Sun Bulletin article. The settlement followed voluntary disclosure to federal authorities after the hospital found the billing problem through an internal audit and took corrective action.

"Due in large part to Lourdes's decision to self-disclose these issues and its cooperation through the government's investigation," the announcement stated, "the hospital was required to pay far less than the treble damages and penalties that the United States is authorized to seek under the False Claims Act." Further, Lourdes Memorial was not required to enter into a corporate integrity agreement with the government or perform other remedial compliance tasks.

"Today's settlement is an excellent example of how voluntary self-disclosure benefits both the integrity of healthcare programs and providers who discover and report evidence of improper billing in their organization," said U.S. Attorney Richard S. Hartunian in the announcement. "Lourdes should be commended for the manner in which it handled the disclosure."

Internal auditing--including proactive reviews of coding, contracts and quality of care--is part of an effective compliance program, according to an Office of Inspector General provider compliance training file.

Self-monitoring is a necessary task for insurers, said attorney Kirk J. Nahra in a FierceHealthPayer eBook, Payer Strategies to Prevent and Detect Fraud. "You need to be identifying compliance risks and checking yourself on a regular basis," Nahra advised. Running a robust compliance program can also position payers to negotiate gains, such as being allowed to self-investigate fraud allegations or reach a compromise for records production in government investigations, Nahra added.

For more:
- read the U.S. Attorney's office announcement (.pdf)
- here's the Press & Sun-Bulletin article
- see the OIG provider compliance training file(.pdf)

>> Download the free FierceHealthPayer eBook, Payer Strategies to Prevent and Detect Fraud

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