Feds reach false claims settlements with 56 hospitals this week

Fifty-five hospitals in 21 states have agreed to pay the United States a total of more than $34 million to settle allegations that they submitted false claims to Medicare for kyphoplasty procedures, the Justice Department announced Tuesday. 

Kyphoplasty is a minimally-invasive procedure that, in most cases, surgeons can safely perform as an outpatient procedure.

The settlements resolve allegations that the hospitals frequently billed Medicare for the more costly inpatient procedure to increase their Medicare billings.

"Whenever hospitals knowingly overcharge Medicare, critically needed resources are wasted and health costs are driven up," Daniel R. Levinson, inspector general for the U.S. Department of Health & Human Services, said in the announcement. "When taxpayers' dollars are threatened, OIG and its federal partners will take action."

The Justice Department has now reached settlements with more than 100 hospitals totaling approximately $75 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures. In addition to Tuesday's settlements, the government previously settled with Medtronic Spine LLC, the corporate successor to Kyphon Inc., for $75 million to settle allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures.  

Meanwhile, the University Medical Center (UMC), which was doing business as University of Louisville (Ky.) Hospital, has voluntarily agreed to pay the United States $2.8 million to settle allegations that it overebilled Medicare for professional services, according to a statement from the U.S. Attorney's Office in West District of Kentucky.

The allegations involve a separate fast-track unit that handles non-urgent care within the University of Louisville Hospital's emergency department. 

According to the announcement, the settlement agreement is neither an admission of liability by UMC nor a concession by the United States that its claims are not well founded.

To learn more:
- here's the announcement, which includes the list of the 55 hospitals 
- read the statement about the UMC settlement

Suggested Articles

Physician groups slammed a court ruling that overturns CMS' site-neutral payments rule for clinic visits.

As the DEA proceeds with the rulemaking process for the Special Registration process, it needs to address important public health priorities.

In a huge win for hospitals, a federal judge has tossed the Trump administration's rule instituting site-neutral payments.