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55 Hospitals to Settle False Medicare Claim Charges for $34M

Margaret Dick Tocknell, for HealthLeaders Media, July 3, 2013

Twenty-three facilities in seven states that are affiliated with the for-profit HCA Inc., six affiliated with Lifepoint, and four with Trinity Health were charged with submitting false claims to Medicare for a procedure to treat spinal fractures.

Fifty-five hospitals in 21 states have agreed to pay more than $34 million to settle allegations that they submitted false claims to Medicare for kyphoplasty procedures, the U.S. Department of Justice announced Tuesday.

Kyphoplasty is a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. It can be performed on an outpatient basis, but the hospitals involved in the settlement admitted patients and billed it as more costly inpatient care, according the DOJ. The DOJ stated that "the claims resolved by these settlements are allegations only, and there has been no determination of liability."

"Hospitals that participate in the Medicare program must bill for their services accurately and honestly," Stuart F. Delery, acting assistant attorney general for the civil division of the DOJ, said in a press statement. He added that the DOJ "is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire of medical providers to maximize profits."

The settling hospitals include 23 facilities in seven states that are affiliated with the for-profit HCA Inc. The Nashville-based healthcare company will pay $7.14 million in settlement monies.

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