For years, the Government has intervened in False Claims Act qui tam cases and/or otherwise recouped monies from health systems based upon inpatient services that lacked medical necessity. Many of these recoveries have involved hospitals submitting claims to Medicare for medically unnecessary one-day stays, which should have been treated as less expensive outpatients.
The most recent example was a March 2015 FCA settlement involving Baptist Health Medical Center-North Little Rock (BHMC), which agreed to pay $2.7 million to settle claims that it improperly billed one-day stays in 2008 and 2009. While this is just the latest in dozens of similar one-day stay FCA settlements, it is noteworthy because of the appended Corporate Integrity Agreement (CIA).
Similar to the CIA put in place after Nolan Auerbach & White’s recent Dignity Health settlement, involving client Kathleen Hawkins, the BHMC Corporate Integrity Agreement requires the health system to submit its claims to annual independent claims reviews for the next five years. In effect, somebody will be looking over their shoulders, scanning for instances of inappropriate billing. Perhaps this added CIA burden will discourage other hospitals from embracing similar alleged business practices.
More information for whistleblowers is located at the Nolan Auerbach & White website.