Page 1 of 6
 
Two hospitals have settled allegations of overcharging the government for infusion therapy and lithotripsy services, the U.S. Attorney for eastern California announced Dec. 7.
Sutter Health Association paid more than $1.4 million for the 25 northern California affiliate hospitals that were involved in the case, the U.S. Attorney stated.
Catholic Healthcare West paid more than $875,000 for the 36 affiliate hospitals in California, Nevada and Arizona that were involved in the case, the U.S. Attorney stated.
The Department of Health and Human Services' Office of Audit Services discovered the two health systems had duplicated charging for the administration of infusion therapy, unbundled infusion therapy services that should have been billed together and duplicated billing of lithotripsy services under separate revenue codes, the U.S. Attorney stated.
Another hospital, New Milford (Conn.) Hospital, had to pay almost $472,000 to resolve False Claims Act allegations involving improper billing for injections of leuprolide acetate, as previously reported in RAC Alert.
Region A RAC Posts 29 Issues
DCS, the Region A RAC, posted 29 inpatient issues Dec. 9 through Dec. 15. For more detail on the issues, see the list below.
Inpatient hospital
|
Name of issue
|
Date posted or approved
|
Regions/states where it is active
|
Description of issue
|
Document sources
|
|
Medical necessity review for MS-DRG 216, cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC
|
12/15/11
|
Conn., Del., D.C., Maine, Mass., N.H., N.J., N.Y., Pa., R.I., Vt.
|
Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.
|
Sect. 1886(d) of the Social Security Act; CMS Pub. 100-08 chapters 6, 13; CMS Pub. 100-02 chapter 1; CMS Pub. 100-04 chapter 3; Highmark LCD L27548; Medicare inpatient fact sheet; Pepper report; OIG reports A-01-10-0100, OAI-09-88-00880, A-03-00-00007, OAI-05-88-00730
|
|
Medical necessity review for MS-DRG 709, penis procedures with CC-MCC
|
12/15/11
|
Conn., Del., D.C., Maine, Mass., N.H., N.J., N.Y., Pa., R.I., Vt.
|
Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.
|
Sect. 1886(d) of the Social Security Act; CMS Pub. 100-08 chapters 6, 13; CMS Pub. 100-02 chapter 1; CMS Pub. 100-04 chapter 3; Highmark LCD L27548; Medicare inpatient fact sheet; Pepper report; OIG reports A-01-10-0100, OAI-09-88-00880, A-03-00-00007, OAI-05-88-00730
|
|
Medical necessity review for MS-DRG 834, acute leukemia without major O.R. procedure with MCC
|
12/13/11
|
Conn., Del., D.C., Maine, Mass., N.H., N.J., N.Y., Pa., R.I., Vt.
|
Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.
|
Sect. 1886(d) of the Social Security Act; CMS Pub. 100-08 chapters 6, 13; CMS Pub. 100-02 chapter 1; CMS Pub. 100-04 chapter 3; Highmark LCD L27548; Medicare inpatient fact sheet; Pepper report; OIG reports A-01-10-0100, OAI-09-88-00880, A-03-00-00007, OAI-05-88-00730
|
|
