Coliseum Health Systems two Macon hospitals are among 23 hospitals affiliated with Hospital Corporation of America that agreed to pay more than $7.14 million to the United States to settle a Medicare fraud case.
The settlement is part of a larger case in which 55 hospitals across the country agreed to pay the government a total of $34 million for submitting false claims to Medicare, according to a Tuesday news release from the U.S. Department of Justice.
The hospitals, including Coliseum Medical Centers, 350 Hospital Drive, and Coliseum Northside Hospital, 400 Charter Blvd., billed Medicare for kyphoplasty procedures as inpatient treatments, rather than outpatient treatments to increase Medicare billings, the news release stated.
Kyphoplasty is a minimally invasive procedure used to treat certain spinal fractures that are often due to osteoporosis. It can be performed safely and effectively as an outpatient procedure without having to admit patients to the hospital, according to the governments news release.
Hospitals that participate in the Medicare program must bill for their services accurately and honestly, Department of Justice Acting Assistant Attorney General Stuart Delery stated in the release. The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on medical needs of patients rather than the desire of medical providers to maximize profits.
All but four of the hospitals announced in Tuesdays settlement were named as defendants in a whistle-blower lawsuit which permits private citizens to bring lawsuits on behalf of the United States and receive a portion of the settlement proceeds, according to the release.
Craig Patrick and Charles Bates filed the lawsuit in Buffalo, N.Y. The men, who worked for Birmingham, Ala.-based Kyphon Inc., will receive $5.5 million from the settlement.
Kyphon sold equipment and materials used to perform kyphoplasty procedures. Patrick and Bates alleged that Kyphon persuaded hospitals to submit false claims to Medicare and other government health care programs by showing how much more revenue the hospitals could generate by billing the procedure as inpatient, rather than outpatient, according to a news release from the whistle-blowers attorneys.
We are pleased to see new clarification of industry care standards, which help physicians make decisions regarding kyphoplasty patients and we are confident as a result that this issue has been resolved, Ed Fishbough of Nashville, Tenn.-based Hospital Corporation of America, said in a prepared statement on behalf of the Macon hospitals and other HCA facilities listed in the settlement.
To date, the Department of Justice has received about $75 million, reaching settlements with more than 100 hospitals accused of overbilling for the kyphoplasty procedures, according to the governments news release.