Rhode Island Hospital will pay $5.3 million to settle claims that it kept about 260 patients overnight unnecessarily and then billed Medicare and Medicaid for those hospital stays, the U.S. Department of Justice announced yesterday.
From 2004 to 2009, the hospital ordered medically unnecessary overnight admissions for patients who had stereotactic radiosurgery (also known as gamma knife treatment) but falsely represented the admissions as medically necessary, according to an FBI investigation.
Under the settlement, the federal government does not dismiss Rhode Island Hospital from any criminal liability or liability to the Internal Revenue Service, the DoJ noted.
The hospital said Medicaid and other private payers have typically preauthorized gamma knife as an inpatient procedure for more than 10 years, noted WPRO News. "Rhode Island Hospital applied this same level of care to Medicare patients, believing it represented the standard practice of care," hospital spokeswoman Ellen Slingsby said in a statement.
Rhode Island Hospital also pointed out that it has updated its assessment process and enhanced employee training to make sure it correctly classifies gamma knife procedures going forward.