UCHealth, the Aurora-based health system, has settled for $23 million after federal allegations surfaced of fraudulent billing practices for emergency department visits. The healthcare provider was accused of violating the False Claims Act by using a billing code that falsely indicated the highest level of hospital resources were used for certain patient visits. The misuse of code CPT 99285 was allegedly routine whenever a patient’s vital signs were checked more than the total hours spent in the emergency department, regardless of the actual resources needed.
The improper billing practice was said to have occurred from November 1, 2017, through March 31, 2021. According to the
U.S. Department of Justice
, Principal Deputy Assistant Attorney General Brian M. Boynton emphasized the importance of holding healthcare providers accountable for submitting inflated or unsupported claims. He articulated that “improperly billing federal health care programs drains valuable government resources needed to provide medical care to millions of Americans.”
The allegations against UCHealth initially arose through a whistleblower lawsuit filed by Timothy Sanders. The False Claims Act provisions permit private individuals to sue on behalf of the United States for fraudulent acts against the federal government and share in any financial recovery. For his role in shedding light on the malpractice, Sanders is slated to receive $3.91 million from the settlement amount, as disclosed in the same Justice Department’s announcement.
Acting U.S. Attorney Matt Kirsch echoed the need for integrity in the healthcare system, as per the
U.S. Department of Justice
, stating, “Fraudulent billing by health care companies undermines Medicare and other federal health care programs that are vital to many Coloradans.” His comments, acclaimed during a review of the settlement, underscored a commitment to hold healthcare companies accountable who adopt automatic coding practices leading to unnecessary and improper billing. The resolution was a combined effort by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the District of Colorado, the Department of Health and Human Services Office of Inspector General (HHS-OIG), and the Defense Criminal Investigative Service.
Authorities have long emphasized the need to tackle healthcare fraud, with the False Claims Act standing as a key instrument in this battle. The act encourages citizens to report potential fraud related to federal healthcare programs. Such reports are taken seriously, as evidenced by the recent UCHealth settlement. According to the
U.S. Department of Justice
, individuals can submit tips and complaints about potential fraud, waste, abuse, and mismanagement through HHS at 800-HHS-TIPS (800-447-8477).
Note: Thank you for visiting our website! We strive to keep you informed with the latest updates based on expected timelines, although please note that we are not affiliated with any official bodies. Our team is committed to ensuring accuracy and transparency in our reporting, verifying all information before publication. We aim to bring you reliable news, and if you have any questions or concerns about our content, feel free to reach out to us via email. We appreciate your trust and support!
Leave a Reply