The United States Department of Justice has announced that 32 hospitals have agreed to pay the United States a total of $28 million to settle the allegations that the health care facilities submitted false claims to Medicare for minimally-invasive kyphoplasty procedures.
"Charging the government for higher cost inpatient services that patients do not need wastes the country's vital health care dollars," said Principal Deputy Assistant Attorney General, Benjamin C. Mizer, head of the Justice Department's Civil Division. "The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire to maximize hospital profits."
The Kyphoplasty procedure is a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. In most common cases, this kind of surgery can be done safely and effectively as an outpatient procedure without any need for a more costly inpatient hospital admission. According to the allegations received by the hospitals in question, these healthcare facilities "frequently billed Medicare for kyphoplasty procedures on a more costly inpatient basis, rather than an outpatient basis, in order to increase their Medicare billings."
"As has been shown throughout this successful investigation, we will never allow hospitals to put profits ahead of patients," said U.S. Attorney William J. Hochul Jr. of the Western District of New York. "Decisions regarding potential procedures should be made using sound medical judgment only, not with an eye toward increasing Medicare reimbursements. The public should be assured that any hospital involved in improper kyphoplasty billing will be held accountable for its actions."
According to the report from West Texas News, the Justice Department has now attained settlements with more than 130 hospitals, totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures with the addition of the new list.