Government Healthcare Programs only pay for claims for hospital admissions that are medically necessary. Claims for one-day inpatient stays that are not medically necessary are ineligible for payment and therefore “false” under the False Claims Act.
Much to the chagrin of wayward hospitals, the federal government is increasingly targeting hospitals with disproportionately high one-day stay rates. Indeed, the government is routinely intervening in False Claims Act qui tam cases founded on fraud allegations, and/or otherwise recouping monies based upon solid evidence that inpatient stays that lacked the requisite medical necessity.
For example, in December 2007, St. Joseph’s Hospital in Atlanta, Georgia, agreed to pay $22 million to settle allegations concerning lack of medical necessity for certain one-day hospital admissions. Similarly, twenty-five other hospitals settled FCA actions in the last four years, quieting allegations that they improperly admitted patients. Most recently, HHS-OIG targeted Beth Israel Deaconess Medical Center, when it subpoenaed documents evidencing impermissible short stays.
More information for healthcare fraud whistleblowers is located at the Nolan & Auerbach, P.A. website.