BUFFALO – In a shocking case of medical malfeasance, 55 hospitals across 21 states have agreed to pay the United States a total of more than $34 million to settle allegations that they submitted false claims to Medicare for kyphoplasty procedures.
Kyphoplasty is a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. According to the allegations, the hospitals frequently billed Medicare for kyphoplasty procedures on a more costly inpatient basis, rather than an outpatient basis, in order to increase their Medicare billings.
“This office will continue to ensure that sound medical decisions determine the ultimate treatment of a patient, not the financial interests of hospitals,” said U.S. Attorney William J. Hochul, Western District of New York. “We will not stand by and allow hospitals to inflate their profits based on unnecessary hospital admissions at the expense of the Medicare program or any other federal program. The settlements announced today will help maintain the integrity of this important program and all government-funded programs.”
The settling facilities, and the amounts they have agreed to pay, include Atrium Medical Center, Middletown, OH, which has agreed to pay $4,232,992.50; Altru Health System, Grand Forks, ND, which has agreed to pay $1,492,690; and Cedars Sinai Medical Center, Los Angeles, CA, which has agreed to pay $1,485,846.
Twenty-three hospitals affiliated with HCA Inc., Nashville, TN, have agreed to pay a total of $7,145,842.72. These include Aventura Hospital & Medical Center (Aventura, FL); Capital Regional Medical Center (Tallahassee, FL); and Coliseum Medical Center (Macon, GA), among others.
Six hospitals affiliated with Lifepoint Hospitals, Inc., Brentwood, TN, have agreed to pay a total of $2,522,502.69. These include Andalusia Regional Hospital (Andalusia, AL); Jackson Purchase Medical Center (Mayfield, KY); and Lake Cumberland Regional Hospital (Somerset, KY), among others.
This case highlights the need for greater transparency and accountability in the healthcare industry. We will continue to monitor and investigate cases of medical malfeasance and hold those responsible accountable for their actions.
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