One Of Nation’s Largest Hospital Systems Agrees To $65M Settlement Over Medicare Overbilling Allegations
Prosecutors had alleged that Prime Healthcare Services unnecessarily admitted Medicare patients who were being treated at the emergency rooms of several hospitals in its system. Medicare pays more for patients who are admitted to hospitals than those who are treated as outpatients.
The Associated Press:
Hospital System Pays $65M To Settle Medicare Billing Claims
Prime Healthcare Services, one of the nation’s largest hospital systems, agreed Friday to pay $65 million to settle allegations of Medicare overbilling in California. The company and CEO Prem Reddy agreed to settle a whistleblower lawsuit alleging that 14 of its hospitals unnecessarily admitted patients and also “upcoded” patient diagnoses, exaggerating their illnesses in order to receive more Medicare money. (8/3)
The Wall Street Journal:
Hospital System, CEO To Pay $65 Million To Settle Lawsuit Alleging Medicare Fraud
Prime Healthcare Services Inc. will pay the bulk of the settlement, while Chief Executive Prem Reddy will pay $3.25 million and the system’s nonprofit affiliate will pay an undisclosed small amount, according to the Justice Department and a Prime spokeswoman. Ontario, Calif.-based Prime also agreed to a five-year corporate integrity agreement with the U.S. Health and Human Service Department’s inspector general. The agreement requires Prime to have an “independent review organization” scrutinize its Medicare bills. Under the terms, the settlement resolves allegations against Prime and its nonprofit affiliate Prime Healthcare Foundation without a determination of liability. (Evans, 8/3)