Federal prosecutors say a Texas-based hospital system has paid millions of dollars to settle a false claims lawsuit.
Christus Spohn Health System Corp. has paid the United States more than $5 million to settle allegations regarding violations of the False Claims Act, U.S. Attorney Kenneth Magidson announced. The allegations included inappropriately admitting patients to inpatient status for outpatient procedures.
The settlement resolves allegations that six Christus Spohn hospitals in and around Corpus Christi, Texas, submitted false claims to the Medicare program by using inpatient codes for procedures that should have been billed under an outpatient code, federal prosecutors said.
Inpatient codes allow the hospitals to collect more money from the Medicare program than they would have using outpatient codes.
The six hospitals included Christus Spohn Hospitals in Corpus Christi – Shoreline, Corpus Christi – Memorial, Corpus Christi – South, Alice, Beeville and Kleberg.
The investigation leading to the settlement began in March 2008 after Christus – Shoreline’s former director of case management filed a lawsuit under seal under the qui tam provisions of the False Claims Act alleging the six hospitals were submitting false claims to the Medicare program by billing for services that should have been performed on an outpatient basis as if they were more expensive inpatient services.
The allegations stated that these hospitals were routinely billing outpatient surgical procedures as if they required an inpatient level of care, which greatly increased the amounts paid to these hospitals by the Medicare program. These patients were often discharged from the hospital in less than 24 hours.
The investigation was conducted by the Department of Health and Human Services – Office of Inspector General. Assistant United States Attorney Andrew A. Bobb managed the investigation and conducted the settlement negotiations.
Source: U.S. Attorney’s Office
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