Sunrise Hospital and Medical Center is one of 55 hospitals in 21 states that have agreed to pay the federal government a total of more than $34 million to settle allegations that the health care facilities submitted false claims to Medicare for a back procedure, according to the U.S. Department of Justice.
The back procedure, known as kyphoplasty, is a minimally invasive procedure that authorities say can be done on an inexpensive outpatient basis, yet Sunrise and other hospitals billed Medicare for the procedures on a more costly inpatient basis, federal officials said.
With Tuesday’s announcement by the Justice Department was a statement by U.S. Attorney William Hochul of New York: “We will not stand by and allow hospitals to inflate their profits based on unnecessary hospital admissions at the expense of the Medicare program.”
Sunrise Hospital officials were not available for comment, but Jeff Prescott, a spokesman for the Nashville, Tenn.-based Hospital Corp. of America, which operates Sunrise, sent an email: “We are pleased to see clarification of industry standards, which help physicians make decisions regarding kyphoplasty patients, and we are confident as a result that this issue has been resolved.”
Twenty-three of the 55 hospitals involved in the current Medicare fraudulent billing practices case are affiliated with HCA, which previously was involved in the largest health care fraud settlement in U.S. history.
Ten years ago, the Justice Department announced that a multiyear probe of HCA resulted in the health care giant paying settlements in 2000 and 2003 totaling $1.7 billion for a variety of allegedly unlawful health care practices, including cost report fraud and the payment of kickbacks to physicians.
This year, HCA will pay more than $7 million of the $34 million settlement. The company did not divulge how much of the settlement is due to procedures done at Sunrise, nor did it reveal which doctors were performing the procedures.