by AT News Team
Four hospitals affiliated with Adventist Health System in Florida were among 14 hospitals which the United States Department of Justice announced this week as settling claims related to “Medicare fraud” totaling $12 million. With similar announcements earlier, more than 40 hospitals have now agreed to pay at least $39 million in connection with surgical procedures in 2000 through 2008.
A Jewish hospital in Long Island, New York, that is included on the list told Bloomberg Businessweek that “the dispute concerned technical billing allegations and denied violating the law.” Bloomberg reported that the hospitals involved agreed to settle “without any admission of liability” because it was less costly to make the payments than to defend themselves in court.
The case originated from “a 2008 whistle-blower lawsuit brought … by two men who had worked for Kyphon Inc., a maker of surgical equipment,” Bloomberg reported, “a former regional sales manager and an ex-reimbursement manager [who] will collect a total of $2.1 million from the settlements.” The company that has bought Kyphon has agreed to pay $75 million.
The key element in these cases is whether seniors with certain spinal fractures related to osteoporosis should have been treated as outpatients or inpatients for a specific kind of procedure. The company “advised hospitals to do inpatient kyphoplasties to bulk up their Medicare payments even though the procedures could have often been done on an outpatient basis,” according to CBS News. “The Justice Department says the hospitals kept the patients in the hospital for extra time so they could get larger payments from Medicare.”
The four Adventist hospitals will pay $3.9 million of the total according to a statement from the Justice Department. “It is inevitable that Adventist hospitals will get caught up in cases like this,” a health planner told Adventist Today. “Whistle-blowers and labels like ‘fraud’ have become all too common in the very complex mechanisms we are using right now in America to manage the cost of health care.”