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Prime Healthcare Services, Medicare Fraud, Pennsylvania 2023
Prime Healthcare Services, a hospital system with 45 acute-care hospitals across 14 states, has agreed to pay $1.25 million to settle allegations that two of its hospitals in Pennsylvania knowingly submitted false claims to Medicare.
The allegations, which were filed under the False Claims Act, claimed that Roxborough Memorial Hospital in Philadelphia and Lower Bucks Hospital in Bristol admitted patients for overnight stays who only required outpatient care, and billed Medicare for more expensive patient diagnoses than the patients actually had, a practice known as ‘up-coding.’
This is not the first time Prime Healthcare Services has been accused of Medicare fraud. In 2018, the company and its CEO, Dr. Prem Reddy, paid $65 million to settle similar allegations arising out of 14 Prime hospitals in California.
The settlement resolves a lawsuit filed by an employee and former employee of Roxborough Memorial Hospital, who brought the allegations under the whistleblower provisions of the False Claims Act.
U.S. Attorney William M. McSwain said, ‘We are committed to ensuring that hospitals, companies that own and operate them, and their executives appropriately bill Medicare. Charging the government for more costly services than what the patient actually needs and billing the government for more serious diagnoses than what the patient actually has is a waste of taxpayer dollars.’
As part of a separate agreement, Prime Healthcare Services entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General, requiring the company to engage in significant compliance efforts over the next five years.
The settlement is a reminder that healthcare companies will be held accountable for their actions, and that whistleblowers play a crucial role in exposing Medicare fraud. As Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services, Philadelphia Regional Office, Maureen Dixon said, ‘We expect health care companies to accurately bill federal health care programs for services they provide, not pad profits by charging for more expensive services than were actually provided.’
Key Facts
- State: Pennsylvania
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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