The health system denies intentionally filing false billings, and has worked with regualtors to resolve the case.
Northwest Arkansas Hospitals, LLC will pay $1.1 million to settle allegations that the not-for-profit health system improperly billed the state's Medicaid program on 246 occasions, Arkansas' U.S. Attorney Tim Griffin says.
Griffin says in a media release that the violations of the Arkansas False Claims Act were found during an audit by the Arkansas Foundation for Medical Care, which showed that records submitted by Northwest Hospitals for its claims "did not justify or support the medically necessary requirement for hospitalizations."
In a statement to the media, Northwest spokeswoman Christina Bull says the submissions to Medicaid "were based on medical evaluations, diagnoses and other supporting documentation created by the unit's former independent medical director Dr. Brian Hyatt and non-physician providers working under his supervision and direction in the unit."
"While there is no evidence that the hospital intended to submit improper claims, we also believe settlement is in the best interest of the organization at this time," Bull says.
Griffin notes that "Northwest has cooperated at all points during this investigation."
"While state and federal law give great deference to the diagnosis made by a medical doctor, all Medicaid providers must maintain complete and accurate records that justify claims filed and fully document the medical necessity of all services," Griffin says.
“While there is no evidence that the hospital intended to submit improper claims, we also believe settlement is in the best interest of the organization at this time.”
Christina Bull, Northwest Arkansas Hospitals, LLC
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
The violations of the Arkansas False Claims Act were found during a recent audit.
Regulators say Northwest has cooperated at 'all points' during the investigation.