Duke agrees to pay $1 mil­lion to set­tle whis­tle-blower law­suit

Modern Healthcare - - REGIONAL NEWS - —Joe Carl­son

Duke Univer­sity Health Sys­tem in Durham, N.C., has agreed to pay $1 mil­lion to re­solve al­le­ga­tions that it fraud­u­lently in­flated its Medi­care bills by un­bundling some car­diac ser­vices and billing for physi­cian as­sis­tants’ time il­le­gally.

The three-hospi­tal sys­tem did not ad­mit wrong­do­ing, but did co­op­er­ate with in­ves­ti­ga­tors af­ter a for­mer rev­enue-cy­cle em­ployee filed a whistle­blower law­suit against the sys­tem that in­cluded the al­le­ga­tions.

“Health­care fraud like this wastes tax dol­lars, harms pa­tients who need care, and drives up med­i­cal costs for all of us,” North Carolina At­tor­ney Gen­eral Roy Cooper said in a writ­ten state­ment. “We’re work­ing closely with federal of­fi­cials to root out this kind of fraud in North Carolina and make wrong­do­ers pay.”

A state­ment from Duke of­fi­cials said that no one at Duke had any in­ten­tion of vi­o­lat­ing the law, and that the govern­ment health­care pro­gram ser­vices im­pli­cated in the al­le­ga­tions did not vi­o­late anti-fraud laws.

“For set­tle­ment pur­poses only, we have agreed to pay back to the Medi­care, Med­i­caid and Tricare pro­grams pay­ments re­ceived over a sixyear pe­riod for claims that re­sulted from an un­de­tected soft­ware prob­lem and through pos­si­ble mis­ap­pli­ca­tion of cer­tain tech­ni­cal billing re­quire­ments,” ac­cord­ing to the hospi­tal’s writ­ten state­ment.

Les­lie John­son, a for­mer health­care bill coder and qual­ity-con­trol au­di­tor for Duke’s rev­enue-cy­cle sub­sidiary, Duke Pa­tient Rev­enue Man­age­ment Or­gani-

za­tion, ac­cused the sys­tem of vi­o­lat­ing the federal and North Carolina false claim acts, which make it il­le­gal to in­ten­tion­ally sub­mit in­flated bills to govern­ment pro­grams. John­son, who now lives in New York, filed her law­suit in De­cem­ber 2012.

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