Whistleblower accuses hospital of fraud under false inpatient status

In an unsealed lawsuit this week, a whistleblower accused Wyoming Medical Center of defrauding Medicare and Medicaid by altering hospital records. The lawsuit states that records clerks changed patient admission status without physician orders, thereby increasing reimbursements, reports the Associated Press today.

From 2006 to 2007, 21 patients received outpatient treatment, and later, their billing status changed from outpatient to inpatient, reports the Casper Star-Tribune. The increased charges ranged from $35 to $1,100, according to the lawsuit.

"WMC, by and under the direction of the highest levels of hospital management, was submitting claim forms that were inconsistent with the medical records for the purpose of obtaining higher levels of reimbursements from both the private and government program insurers," the lawsuit states.

Gale Bryden, the whistleblower, said she alerted hospital administrators in the fall of 2006 when she suspected inappropriate billing. However, Vickie Diamond, then-chief operating officer and now hospital president, said there was no meeting with Bryden about fraudulent billing.

Wyoming Medical Center's attorney, Dick Williams, said if there were billing inaccuracies that occurred, they were accidental.

"We have denied from day one that there was any intent to improperly bill the government ... or that there was a systematic direction from anyone to alter statuses or records," he said.

The hospital is working on a settlement, according to the Casper Star-Tribune.

For more information:
- read the AP article
- read the Casper Star-Tribune article

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