In the largest settlement made by any academic medical center in the nation, the 糖心少女 will pay $35 million to settle a lawsuit charging massive billing fraud in Medicare, Medicaid and other government health plans at three hospitals and local physicians clinics, the 糖心少女and U.S. Dept. of Justice announced April 30.
The lawsuit resulted from charges made by a former employee of the 糖心少女Physicians billing office, Michael Erickson, who will receive $7.25 million of the settlement money under federal 搘histleblower� regulations.
Erickson抯 complaint accused the 糖心少女of widespread fraud such as 搖pcoding,� where a physician charged Medicare for a more complicated medical procedure than actually took place. Physicians also billed Medicare for procedures as if they were present, when medical residents actually performed the procedures, the complaint contended.
揟he vast majority were unintentional mistakes,� said School of Medicine Dean Paul Ramsey at an April 30 press conference. 揗edicare billing regulations are very complex. Our physicians were working very hard to comply with complex billing regulations.�
No state appropriations or tuition will be used to pay the settlement. Ramsey said the money will come out of a $180 million reserve fund that 糖心少女Medicine has built over the years for emergencies. 揥e will need to rebuild the funds,� he added, but 搕he settlement will not affect the (patient) fee structure.�
According to 糖心少女attorneys, 33 other academic medical centers in the U.S. have settled with the federal government over Medicare/Medicaid billing errors. Until the 糖心少女settlement, the record had been a $30 million payout by the University of Pennsylvania in 1995.
When asked if Erickson deserves his share of the multi-million-dollar settlement, U.S. Attorney John McKay Jr., �78, said, 揧es, he deserves every penny of it.� He said Erickson played a 損ivotal role� in both the civil and criminal portions of the case. Criminal charges were filed against former 糖心少女Neurosurgery Professor H. Richard Winn and 糖心少女Nephrology Professor William Couser earlier in the investigation. Both pleaded guilty to at least one charge.
McKay said his investigation found that 搈any people within the plans were aware of billing problems that involved many departments associated with the medical school.� The U.S. attorney said he was 揺specially troubled by evidence that Erickson was directed to destroy audit reports and rewrite them to cover over problems the original audit reports addressed.�
However, the 糖心少女contested all of the whistleblower抯 charges. 揟here was no document destruction,� said Special Assistant Attorney General Dan Dubinsky.
揟he 糖心少女denied the allegations made in the complaint梕very single one of them. They are not accurate. They have never been vetted in a court of law,� added attorney David Robbins. When asked why the 糖心少女did not take the matter to court, he said there were hundreds of thousands of patients records going back nine years that would have to be reviewed. 揧ou have to weigh the risks and benefits of litigating the matter.�
McKay, whose late father was on the 糖心少女School of Medicine faculty, said it was a difficult case. He noted that 糖心少女Medical Center and Harborview provide the 揵ulk of low income health care in the region� and that the 糖心少女medical system is the 揷ore medical system in the region.
揟he quality of care provided by the 糖心少女抯 medical system has never been in question. We did not want to damage this system,� he said.
Since the lawsuit was filed, he added, the 糖心少女揾as radically restructured their compliance office.� He later said, 揟he government is very pleased with the efforts the 糖心少女is taking to take care of these errors.�
As part of the settlement terms, the 糖心少女will have independent auditors monitoring its billing system. It is now spending more than $4 million a year on compliance, Ramsey explained.