When hospitals unnecessarily admit Medicare patients for short inpatient stays when the appropriate treatment would be outpatient or observation care, they improperly boost hospital profits at significant expense to taxpayers and patients. According to the Justice Department, Beth Israel Deaconess Medical Center (BIDMC) allegedly did just that, when it allegedly billed Medicare for inpatient admissions that should have been billed as lower reimbursed outpatient or observation services. These supposed false claims were submitted from June 1, 2004, through March 31, 2008.
Specifically, the government alleged that BIDMC inappropriately submitted claims to Medicare for one-day stay inpatient admissions for patients with congestive heart failure, chest pain, and certain digestive and nutritional disorders. These claims supposedly should have been billed as observation services, as the patients were briefly admitted for the limited purpose of observation and discharged the next day. In addition, the government alleged that BIDMC submitted claims to Medicare for less-than-one day (zero day) stays that should have been billed as outpatient or observation services.
Such improper inpatient admissions drain government dollars, for Medicare reimburses hospitals at significantly higher amounts for inpatient admissions compared to outpatient or observation services. When confronted by the government, BIDMC agreed to pay the United States $5.315 million to settle the alleged False Claims Act violations.
Of particular note, neither the government nor BIDMC credit a qui tam whistleblower with raising these allegations. If this was a government-initiated False Claims Act case, this would be one of the few successful FCA cases that was not initiated by a whistleblower.
More information for whistleblowers is located at the Nolan Auerbach & White website.