Atrium Medical Center in Middletown, Ohio, is one of 55 hospitals across 21 states that will pay a total of $34 million to resolve allegations that the hospitals overcharged Medicare for performing a type of spinal surgery called kyphoplasty. Kyphoplasty is a procedure used to reduce pain from spinal compression fractures that often result from osteoporosis. The procedure is minimally invasive and typically performed on an outpatient basis.
The Department of Justice (DOJ) alleged that the hospitals admitted patients for inpatient hospital stays and misrepresented the patient’s treatment to increase Medicare reimbursement. A DOJ press release announced that Atrium Medical Center, part of the Dayton-based Premier Health network, is paying just over $4.2 million, the largest share of any single hospital. The settlement did not include a determination of liability.
The DOJ has been investigating hospitals’ kyphoplasty billing practices since 2008, following a whistleblower lawsuit. This settlement brings the federal government’s total recovery for kyphoplasty billing fraud cases to approximately $75 million. This settlement reiterates the importance of proper coding and billing by providers, and the ongoing vigilance of the government in pursuing providers who submit improper claims for care or otherwise try to enhance payments at the expense of governmental programs.
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