Denton Regional Medical Center was part of a large settlement this week reached between its parent company, Hospital Corporation of America Inc., and the federal government to settle allegations the hospital and 22 other HCA affiliates submitted false claims to Medicare.
Either together or through HCA Inc., the hospitals must pay $7.1 million to the United States, according to the settlement. HCA’s settlement is one of several reached this week regarding the claims, impacting 55 hospitals nationwide and costing more than $34 million.
Denton Regional Medical Center and other HCA hospitals settled allegations that the facilities submitted false claims for kyphoplasty procedures, a minimally-invasive procedure to treat certain spinal fractures that is normally an outpatient procedure.
The settlement notes that the HCA hospitals submitted inpatient claims on certain kyphoplasty procedures performed between Jan. 1, 2000 and Dec. 31, 2008. These procedures should have been billed as outpatient “due to the absence of medical necessity for an inpatient level of service.”
“We are pleased to see new clarification of industry care standards, which help physicians make decisions regarding kyphoplasty patients, and we are confident that this issue has been resolved,” said HCA spokesman Ed Fishbough in an e-mail.
Officials from Denton Regional Medical could not be reached for comment.
The original lawsuit was filed in 2008 in federal district court in Buffalo, N.Y., by two former Kyphon employees under the False Claims Act, according to the Department of Justice. Kyphon is the company which sells the equipment and materials to perform the procedure.
Craig Patrick, a former reimbursement manager, and Charles Bates, a former regional sales manager, said Kyphon persuaded hospitals to submit false claims, according to a press release from the pair’s representing firm, Phillips & Cohen LLP.
Now more than 100 hospitals have settled for approximately $75 million with the federal government for allegedly filing false claims with Medicare for kyphoplasty procedures, the Department of Justice reported.
JENNA DUNCAN can be reached at 940-566-6889 and via Twitter at @JennaFDuncan.