Hospitals to pay US more than $28 million to resolve False Claims Act allegations related to kyphoplasty billing

Thirty-two hospitals in 15 states have agreed to pay the United States more than $28 million to settle allegations they mischarged Medicare for minimally invasive kyphoplasty procedures, the Justice Department announced. This means the Justice Department has now reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations they mischarged Medicare for kyphoplasty procedures.

The recently resolved allegations centered around 32 hospitals that frequently billed Medicare for kyphoplasty procedures on a more costly inpatient basis, rather than an outpatient basis, a practice that increased the hospitals’ Medicare billings.

“Charging the government for higher cost inpatient services that patients do not need wastes the country’s vital health care dollars,” Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, said in a press release. “The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire to maximize hospital profits.”

The 32 hospitals each agreed to pay different settlement amounts.

All but three of the hospitals involved in the settlements were defendants in a “qui tam,” or whistleblower, lawsuit brought under the False Claims Act. The lawsuit was filed in federal district court in Buffalo, N.Y.

In addition to settlements with over 130 hospitals, the government previously settled with Medtronic Spine LCC, the corporate successor to Kyphon Inc., for $75 million to settle allegations the company caused false claims to be submitted to Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures, according to the Dec. 18 press release.

Reference: www.justice.gov