Hospitals to pay millions for alleged overbilling in Florida, Texas

A Texas hospital and radiology group settled a federal lawsuit with the U.S. Attorney's office Tuesday over illegal double billing, KRIS-TV reported.

According to federal prosecutors, Driscoll Children's Hospital-owned Children's Physician Services of South Texas and Radiology Associates each billed the government for the same procedure over five years, resulting in at least $12.3 million in wrongful reimbursement, according to the report.

"Prosecutors said the children's clinic billed the government twice, once for the cost of taking the genetic ultrasound and once for the cost of interpreting the ultrasound, despite an agreement with the radiology clinic that each office would only bill for one component of the exam," according to the article. The ultrasounds were ordered for women with risky pregnancies.

The settlement left Driscoll Health with a $1.5 million bill and Radiology Associates with $800,000. Driscoll Children's Hospital, in a statement, called the claims a "matter of interpretation" and said the hospital system settled "to avoid the delay, uncertainty, inconvenience and expense of protracted litigation," KRIS-TV reported

Meanwhile, a whistleblower lawsuit filed against Florida Hospital continues in federal court even after the nonprofit hospital repaid $3 million in government overpayments, reported the Orlando Sentinel.

Paying back the money shows "the hospital knew what was going on and that it was wrong," said Patrick Burns, spokesman for Washington-based Taxpayers Against Fraud, the Sentinel reports. Florida Hospital maintains the repayment stemmed from a routine audit.

The whistleblower suit also accuses six other Adventist Health System hospitals in Florida of overbilling the government for tens of millions of dollars for more than 10 years.

The Office of Inspector General reported in late February that the Centers for Medicare & Medicaid Services has failed to collect about $226 million in Medicaid overpayments.

To learn more:
- read the KRIS-TV report
- read the Orlando Sentinel article

Related Articles:
Millions of Medicaid overpayments remain uncollected
RACs recoup $745M in overpayments
Medical necessity top reason for RAC denials