The following eight settlements involving hospitals and/or health systems occurred within the past month.
1. Kentucky's Baptist Health, Hardin Memorial to Pay Nearly $9M to Settle Claims of Improper Medicare Billing
Louisville, Ky.-based Baptist Health System agreed to pay $5.79 million and its subsidiary, Hardin Memorial Hospital in Elizabethtown, Ky., agreed to pay $3.12 million to the government to settle claims of improper Medicare billing. The government claims that, from 2001-2006, Baptist and Hardin improperly billed Medicare by billing for serious conditions that resulted in higher reimbursements than warranted by the actual conditions of patients treated.
2. Maryland Hospital to Pay $1.8M to Settle Federal Claims That it Permitted Unnecessary Stent Procedures
Peninsula Regional Medical Center in Salisbury, Md., agreed to pay $1.8 million to settle federal claims that it failed to prevent its cardiologist from implanting medically unnecessary stents in dozens of patients from 2003-2006. John R. McLean, MD, was convicted last month of healthcare fraud and other charges related to his practice of falsifying patient records to create a need for stents, then billing insurers for hundreds of thousands of dollars for the procedure.
3. St. Francis Hospital in Connecticut to Pay $516K for Medicare Billing Errors
St. Francis Hospital and Medical Center in Hartford, Conn., agreed to pay $516,527 to settle a federal complaint that it overbilled Medicare for prostate cancer treatments. The allegations involved the treatment of cancer patients with Lupron. Male and female patients require different dosages, but the government asserted that St. Francis used higher-paying female billing codes when seeking reimbursement for male patients from 2001-2009.
4. LifePoint Hospitals to Pay $1M Settlement for Alleged Medicare Overbilling
Brentwood, Tenn.-based LifePoint Hospitals agreed to pay a settlement of approximately $1 million to resolve allegations of false Medicare billing at Jackson Purchase Medical Center in Mayfield, Ky. The alleged overbilling occurred from 2004-2010. The U.S. Attorney's office said it came to light after a beneficiary reported to Medicare that she had been billed for inpatient treatment rather than outpatient care, which is what she received.
5. California's El Centro Regional to Pay $1.1M After Self-Reporting Improper Billing Related to Excluded Employees
El Centro (Calif.) Regional Medical Center will pay more than $1.1 million to the federal government after it self-reported that four hospital employees were listed on the Office of Inspector General exclusion-from-employment list. Three nurses and one lab worker were immediately removed from their positions once the hospital discovered their status. The three employees then resolved their issues with the OIG, were removed from the exclusion list and then rehired by the hospital.
6. Geisinger Medical Center to Pay $1.3M to Settle Charges of Improper Medicare Billing
Geisinger Medical Center in Danville, Pa., agreed to pay the federal government $1.3 million to resolve allegations of improper Medicare billing. The alleged overbilling took place from Jan. 2001-Dec. 2006. U.S. Attorney Peter J. Smith claimed the hospital submitted Medicare claims that contained management services not allowable under Medicare requirements. More specifically, Medicare doesn't normally issue additional payments for management services offered by a provider the same day a procedure is performed. These "Modifier 25" services were allegedly incorrectly attached to Geisinger's claims, resulting in Medicare's overpayment.
7. N.C. Baptist Hospital Pays $5.4M to Settle Claims of Overbilling Employees for Health Coverage
N.C. Baptist Hospital in Winston Salem, N.C., will pay approximately $5.4 million to settle a federal suit alleging its group health plan required employees to pay more in fees than other corporate clients paid. The suit claimed the hospital selected a network in which it had a stake because it would provide the greatest reimbursement and would help ensure other large networks did not gain additional market share, driving down future reimbursements that NCBH might receive.
8. 4 Kentucky Providers Will Repay $26.4M to Passport Health Plan as Part of Settlement
As part of a civil settlement, four providers who also were investors in Passport Health Plan will repay $26.4 million to the provider-sponsored HMO, based in Louisville, Ky. The four Passport investor-members will each pay the plan back as restitution for alleged improper and illegal cash transfers received in 2008, 2009 and 2010. The providers, each based in Louisville, are: University Physicians Associates, Norton Hospital, Jewish and St. Mary's Healthcare and University Medical Center.
5 Hospitals and Health Systems Embattled in Lawsuits
10 Recent Stark, False Claims and Kickback Lawsuits Involving Hospitals and Health Systems
1. Kentucky's Baptist Health, Hardin Memorial to Pay Nearly $9M to Settle Claims of Improper Medicare Billing
Louisville, Ky.-based Baptist Health System agreed to pay $5.79 million and its subsidiary, Hardin Memorial Hospital in Elizabethtown, Ky., agreed to pay $3.12 million to the government to settle claims of improper Medicare billing. The government claims that, from 2001-2006, Baptist and Hardin improperly billed Medicare by billing for serious conditions that resulted in higher reimbursements than warranted by the actual conditions of patients treated.
2. Maryland Hospital to Pay $1.8M to Settle Federal Claims That it Permitted Unnecessary Stent Procedures
Peninsula Regional Medical Center in Salisbury, Md., agreed to pay $1.8 million to settle federal claims that it failed to prevent its cardiologist from implanting medically unnecessary stents in dozens of patients from 2003-2006. John R. McLean, MD, was convicted last month of healthcare fraud and other charges related to his practice of falsifying patient records to create a need for stents, then billing insurers for hundreds of thousands of dollars for the procedure.
3. St. Francis Hospital in Connecticut to Pay $516K for Medicare Billing Errors
St. Francis Hospital and Medical Center in Hartford, Conn., agreed to pay $516,527 to settle a federal complaint that it overbilled Medicare for prostate cancer treatments. The allegations involved the treatment of cancer patients with Lupron. Male and female patients require different dosages, but the government asserted that St. Francis used higher-paying female billing codes when seeking reimbursement for male patients from 2001-2009.
4. LifePoint Hospitals to Pay $1M Settlement for Alleged Medicare Overbilling
Brentwood, Tenn.-based LifePoint Hospitals agreed to pay a settlement of approximately $1 million to resolve allegations of false Medicare billing at Jackson Purchase Medical Center in Mayfield, Ky. The alleged overbilling occurred from 2004-2010. The U.S. Attorney's office said it came to light after a beneficiary reported to Medicare that she had been billed for inpatient treatment rather than outpatient care, which is what she received.
5. California's El Centro Regional to Pay $1.1M After Self-Reporting Improper Billing Related to Excluded Employees
El Centro (Calif.) Regional Medical Center will pay more than $1.1 million to the federal government after it self-reported that four hospital employees were listed on the Office of Inspector General exclusion-from-employment list. Three nurses and one lab worker were immediately removed from their positions once the hospital discovered their status. The three employees then resolved their issues with the OIG, were removed from the exclusion list and then rehired by the hospital.
6. Geisinger Medical Center to Pay $1.3M to Settle Charges of Improper Medicare Billing
Geisinger Medical Center in Danville, Pa., agreed to pay the federal government $1.3 million to resolve allegations of improper Medicare billing. The alleged overbilling took place from Jan. 2001-Dec. 2006. U.S. Attorney Peter J. Smith claimed the hospital submitted Medicare claims that contained management services not allowable under Medicare requirements. More specifically, Medicare doesn't normally issue additional payments for management services offered by a provider the same day a procedure is performed. These "Modifier 25" services were allegedly incorrectly attached to Geisinger's claims, resulting in Medicare's overpayment.
7. N.C. Baptist Hospital Pays $5.4M to Settle Claims of Overbilling Employees for Health Coverage
N.C. Baptist Hospital in Winston Salem, N.C., will pay approximately $5.4 million to settle a federal suit alleging its group health plan required employees to pay more in fees than other corporate clients paid. The suit claimed the hospital selected a network in which it had a stake because it would provide the greatest reimbursement and would help ensure other large networks did not gain additional market share, driving down future reimbursements that NCBH might receive.
8. 4 Kentucky Providers Will Repay $26.4M to Passport Health Plan as Part of Settlement
As part of a civil settlement, four providers who also were investors in Passport Health Plan will repay $26.4 million to the provider-sponsored HMO, based in Louisville, Ky. The four Passport investor-members will each pay the plan back as restitution for alleged improper and illegal cash transfers received in 2008, 2009 and 2010. The providers, each based in Louisville, are: University Physicians Associates, Norton Hospital, Jewish and St. Mary's Healthcare and University Medical Center.
Related Articles on Hospitals, Lawsuits and Settlements:
6 Recent Lawsuits Involving Hospitals5 Hospitals and Health Systems Embattled in Lawsuits
10 Recent Stark, False Claims and Kickback Lawsuits Involving Hospitals and Health Systems