Hospital to pay $9.5 million for Medicare billing issues

A hospital in Greenville, SC, will pay nearly $9.5 million to resolve Medicare billing improprieties from 1997 through 1999 in its home health, hospice, and durable medical equipment programs, the Office of Inspector General (OIG) announced recently. The settlement is the largest reached in such cases. Acting Principal Deputy Inspector General Dara Corrigan announced the settlement with St. Francis Hospital, which self-disclosed the improper billing.

When purchasing St. Francis in 2000, Bon Secours Health System discovered billing and documentation problems at St. Francis and then launched an internal investigation that revealed "significant error rates and systematic documentation lapses" in its Medicare billings, Corrigan says. The hospital brought its findings to OIG under the Self-Disclosure Protocol, which encourages providers to approach the government voluntarily when they uncover evidence of potential fraud and compliance problems in their organizations.

Under the Self-Disclosure Protocol, OIG outlines how providers should investigate and audit compliance problems and works with disclosing providers to resolve the situation. Corrigan says St. Francis was subject to much higher penalties than the settlement amount, but it quickly took corrective steps to remedy the problems.