WASHINGTON – Seven hospitals located in Florida, Mississippi, Texas, South Carolina, North Carolina and Alabama have agreed to pay the United States a total of more than $6.3 million to settle allegations that the health care facilities submitted false claims to Medicare, the Justice Department announced today.
The settlements resolve allegations that these hospitals overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis.
In many cases, the procedure can be performed safely as a less costly out-patient procedure, but the government contends that the hospitals performed the procedure on an in-patient basis in order to increase their Medicare billings.
“Hospitals that participate in the Medicare program must bill for their services accurately and honestly,” said Tony West, Assistant Attorney General for the Department’s Civil Division. “The Department of Justice is committed to ensuring that Medicare funds are expended appropriately.”
“These settlements show the continuing commitment by the U.S. Attorney’s Office to investigate and recover any improper billings for kyphoplasty procedures which the hospitals inappropriately classified as inpatient, rather than outpatient,” said William J. Hochul Jr., U.S. Attorney for the Western District of New York.
“These actions not only protect taxpayers and the integrity of the Medicare program in the short term, they will in the long run help ensure optimal care for Medicare beneficiaries, by insisting that medicine, and not money, be used to determine the best course medical decision for a given case.”
The settling facilities include the following: Lakeland Regional Medical Center, Lakeland, Fla. ($1,660,134.49); The Health Care Authority of Morgan County – City of Decatur dba Decatur General Hospital, Decatur, Ala. ($537,892.88); St. Dominic-Jackson Memorial Hospital, Jackson, Miss. ($555,949.35); Seton Medical Center, Austin, Texas ($1,232,955.91); Greenville Memorial Hospital, Greenville, S.C. ($1,026,764.01); Presbyterian Orthopaedic Hospital, Charlotte, N.C.($637,872.57); and The Health Care Authority of Lauderdale County and the City of Florence, Ala., dba the Coffee Health Group, fka Eliza Coffee Memorial Hospital ($676,038.00).
The settlements with these facilities follow the settlements that the government reached in May 2009, September 2009, and May 2010 with 18 other hospitals for kyphoplasty-related Medicare claims, as well as the government’s May 2008 settlement with Medtronic Spine LLC, corporate successor to Kyphon Inc.
Medtronic Spine paid $75 million to resolve allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as an in-patient procedure, even though the minimally-invasive procedure should have been done in many cases as an out-patient procedure.
All of the settling facilities were named as defendants in a lawsuit filed under the False Claims Act in 2008 in federal district court in Buffalo, New York by Craig Patrick and Charles Bates. The qui tam, or whistleblower, provisions of the Act permit private citizens, called “relators,” to file lawsuits on behalf of the United States and share in any recovery.
Mr. Patrick of Hudson, Wis., is a former reimbursement manager for Kyphon, and Mr. Bates was formerly a regional sales manager for Kyphon in Birmingham, Ala.
The relators will receive a total of approximately $1.1 million as their share of the settlement proceeds.
“Hospitals overcharging Medicare take critically needed resources necessary to provide quality care and drive up health care costs,” said Daniel R. Levinson, Inspector General for the U.S. Department of Health and Human Services.
“When Medicare and taxpayers' dollars are threatened, OIG and its federal partners will hold perpetrators accountable.”
Assistant Attorney General West noted that the settlements with these hospitals were the result of a coordinated effort among the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Western District of New York, and the Department of Health and Human Services’ Office of Inspector General and Office of Counsel to the Inspector General.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009.
The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.
One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $4.2 billion since January 2009 in cases involving fraud against federal health care programs.
The Justice Department's total recoveries in False Claims Act cases since January 2009 have topped $6.8 billion.