CHS to pay $97 mil­lion to set­tle short-stay in­ves­ti­ga­tion

Modern Healthcare - - NEWS - By Bob Her­man

Com­mu­nity Health Sys­tems has agreed to pay more than $97 mil­lion plus in­ter­est to the fed­eral govern­ment to set­tle al­le­ga­tions that it sub­mit­ted false claims for short-stay ad­mis­sions that should have been billed as out­pa­tient charges.

The set­tle­ment, an­nounced by CHS and the Jus­tice De­part­ment last week, came with no find­ing of im­proper con­duct by CHS or its hos­pi­tals, and CHS has de­nied any wrong­do­ing, the Franklin, Tenn.-based sys­tem said.

At is­sue were billing prac­tices of 119 CHS hos­pi­tals be­tween Jan­uary 2005 and De­cem­ber 2010. Sev­eral whistle­blow­ers al­leged CHS ad­mit­ted pa­tients through its emer­gency de­part­ments and then billed Medi­care, Med­i­caid and the mil­i­tary’s Tricare for “med­i­cally un­nec­es­sary” in­pa­tient stays or pro­ce­dures, when pa­tients should have been treated as out­pa­tients or placed on ob­ser­va­tion. The whis­tle-blow­ers also said CHS had set cer­tain ad­mis­sions bench­marks to im­prove prof­itabil­ity.

The set­tle­ment also re­solved sep­a­rate al­le­ga­tions of in­ap­pro­pri­ate car­diac and hemodial­y­sis ser­vices and self-re­fer­rals at CHS’ Laredo (Texas) Med­i­cal Cen­ter.

Wayne Smith, CEO of CHS, said his com­pany hopes to work more closely with the govern­ment to de­ter­mine what con­sti­tutes ap­pro­pri­ate in­pa­tient care, be­cause “shift­ing and of­ten am­bigu­ous stan­dards make it ex­tremely dif­fi­cult for physi­cians and hos­pi­tals to con­sis­tently com­ply with the reg­u­la­tions,” he said.

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