Staff Report
Published May 18, 2010
Palmetto Health has agreed to pay the U.S. government more than $1.8 million to settle allegations that Palmetto Health Baptist Hospital submitted false claims to Medicare, the U.S. Department of Justice reported Monday.
Palmetto Health said the settlement is not an admission of guilt, and there has been no finding of fact in the settlement, the hospital said in a statement.
Palmetto Health settled a case with the Department of Justice related to allegations about billing for certain kyphoplasty procedures — minimally invasive spinal surgery used to treat spinal fractures caused mainly by osteoporosis — performed at the hospital.
“Excellent patient care was provided to every patient involved in these cases, as it is with all those we care for at our hospitals,” the hospital said. “Based on the physician’s judgment of medical necessity at time of admission, Palmetto Health kept patients in the hospital overnight. The issue related to this case is about documentation of the care provided and whether they should have been billed as an outpatient procedure rather than an inpatient procedure. According to the Department of Justice, there was not enough documentation in the patient record to justify billing the procedure as an overnight stay.
“As with any concern brought to our attention, Palmetto Health will closely monitor this kind of patient case to ensure that proper documentation is in place.”
Palmetto was one of nine hospitals involved in the settlement. The others were in Alabama, Indiana, Florida, Michigan, New York and Minnesota. Total reimbursement to the government is $9.4 million. The settlements resolve allegations that the hospitals overcharged Medicare between 2000 and 2008 when performing kyphoplasty. In many cases, the procedure can be performed as an outpatient procedure, but the government contends that the hospitals performed the procedure on an inpatient basis in order to increase their Medicare billings.
The other facilities that are settling are:
| Facility | Location | Amount |
“These hospitals put profits ahead of sound medical judgment,” said Tony West, assistant attorney general for the civil division of the Department of Justice. “The Justice Department is committed to protecting Medicare funds from waste and abuse.”
This settlement is part of the government's emphasis on combating health care fraud. The Justice Department has recovered approximately $2.2 billion since January 2009 in cases involving fraud against federal health care programs.
