George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 8, 2016, a Pennsylvania hospital accused of overbilling Medicare agreed to settle civil claims with the federal government for $325,000, the U.S. Attorney’s office in Philadelphia announced. The case arose out of allegations that the hospital used inpatient diagnosis codes for routine outpatient procedures.

Northampton Hospital Co. LLC (Northampton), which operates Easton Hospital, has agreed to resolve allegations of improper Medicare billing for inpatient procedures performed at the health care facility from January 1, 2008, through June 27, 2014, the U.S. Department of Justice (DOJ) said in a press release. Click here to read the press release in full.

Overbilling Medicare.

Northampton provides inpatient and outpatient health care services in Easton, Pennsylvania. The hospital’s services include cardiovascular, orthopedic, oncology, maternal, child health, pediatric, physical therapy rehabilitation, and mental health services. In addition, it offers surgical care, emergency care, occupational and speech therapy, wound healing management, imaging, radiology, home health, hospice, and laboratory services.

According to the DOJ, Northampton allegedly billed inpatient Medicare Part A claims using particular primary diagnosis codes that did not justify patient admission to an acute care hospital. The improper codes that were used correspond primarily to long-term, stable conditions.

“According to the United States, these primary diagnosis codes were used to justify inpatient admissions for routine procedures that should have instead been performed on an outpatient basis,” the office said. “Had these procedures been performed on an outpatient basis, the procedures would have been billed at a lower rate.”

Northampton agreed to pay a total of $325,000 to settle the allegations of overbilling Medicare.

To read a similar case of overbilling Medicare and the repercussions, click here to read one of my prior blogs.

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The Health Law Firm’s attorneys routinely represent physicians, dentists, nurses, medical groups, nurse practitioners, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. The attorneys at The Health Law Firm, have defended individual health professionals and health facilities in false claims act and whistle blower cases. The attorneys at The Health Law Firm, have also represented plaintiffs (relators or “whistle blowers”) in bringing qui tam or false claims act cases against those involved in falsely billing Medicare.

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Wolf, Alex. “Pa. Hospital Settles Medicare Overbilling Claims For $325K.” Law360. (August 8, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone; (407) 331-6620.

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