Outpatient services allegedly billed as though they were more expensive inpatient services landed Christus Spohn Health System Corporation in a False Claims Act settlement for $5.1 million.
The health system, which has six hospitals, will pay to settle the allegations, which were brought by Christus-Shoreline's former director of case management, according to the U.S. Attorney's Office in southern Texas.
The six Christus Spohn Hospitals in Corpus Christi-Shoreline, Corpus Christi-Memorial, Corpus Christi-South, Alice, Beeville and Kleberg collected more Medicare money than they should have by billing inpatient codes when outpatient codes were appropriate, the U.S. Attorney stated.
The investigation into the charge began in March 28. The whistleblower will receive 20 percent, or about $1 million, of the $5 million settlement.
For more information, visit http://www.justice.gov/usao/txs/1News/Releases/2012%20June/120614%20Christus%20Spohn.html.
In other fraud news, OIG captured another of its most wanted health care fugitives, Irina Shelikhova, who allegedly was the "primary player in a scheme to defraud Medicare of more than $70 million," OIG stated on its website.
Working at New York City-area medical clinics, Shelikhova allegedly paid cash kickbacks to Medicare beneficiaries for them to receive unnecessary physician services, physical therapy and diagnostic tests from March 2005 to July 2010, the OIG stated.
Co-conspirators in the scheme created fraudulent medical records and filed false claims that were not provided or not necessary, OIG stated.
Shelikhova, who was suspected to be living in Ukraine after leaving the United States in July 2010, was arrested by the FBI at JFK Airport in New York.
For more information on Shelikhova's case, visit http://oig.hhs.gov/fraud/fugitives/captured_profiles.asp.
In recovery auditor (RAC) news, no RACs posted issues this week.
About the Author
Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.
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