Beth Israel Deaconess Medical Center (BIDMC) has agreed to pay $5.3 million to settle allegations that it submitted improper Medicare claims for inpatient admissions that should have been billed as oupatient or observation services, the U.S. Department of Justice (DOJ) announced yesterday.
Between June 1, 2004, and March 31, 2008, the Boston teaching hospital submitted the improper inpatient claims for patients with congestive heart failure, chest pain, and certain digestive and nutritional disorders who were briefly admitted for the limited purpose of observation and discharged the next day, according to the DOJ.
Beth Israel has denied any wrongdoing as part of the settlement but said it has taken several steps, including enhancing its billing classification system and creating a new position in charge of compliance, the Boston Herald reported.
"BIDMC is committed to delivering the appropriate level of care to patients in need and ensuring that the hospital is in full compliance with all applicable rules and regulations," the teaching hospital said in statement, the Herald noted.
While Beth Israel's statement called the distinction between inpatient and observation stay "an extremely technical issue," the DOJ suggested the hospital may have made improper inpatient claims to reap higher Medicare reimbursements.
"When hospitals unnecessarily admit Medicare patients for short inpatient stays when the appropriate treatment would be outpatient or observation care, they improperly boost hospital profits at significant expense to taxpayers and patients," Susan J. Waddell, special agent in charge of the U.S. Department of Health & Human Services, Office of Inspector General, said in the announcement. "We are committed to uprooting such schemes to eliminate waste in federal healthcare programs."