A whistleblower lawsuit accused Medical City Healthcare parent company HCA Healthcare of bilking the federal government out of millions at their rehabilitation hospitals through inflated or fraudulent billing, Modern Healthcare reports.
HCA is no stranger to former employees exposing questionable Medicare billing practices, as it was subject to one of the longest government investigations which began in 1993 and concluded when a settlement was reached in 2002 which cost the hospital chain $1.7 billion, which was the largest health fraud settlement in history at the time.
A former occupational therapist alleges that HCA submitted false claims across 18 states, attempting to receive higher reimbursement rates from the Inpatient Rehabilitation Facility Prospective Payment System rather than the Inpatient Prospective Payment System. Inpatient rehabilitation hospitals receive better reimbursement rates when 60 percent of patients have more acute needs from 13 different conditions, says Modern Healthcare.
Modern Healthcare reports that the government decided not to act on the lawsuit, but the claimant says HCA retaliated by firing her. The claimant alleges that patients were left unsupervised while the time was billed as therapy and staff were told to rely on physical symptoms rather than diagnostic tests when sending patients to physicians. The suit also alleges that claims were submitted for unnecessary care, fake diagnoses, inaccurate therapy times, and with missing or backdated physician orders.
The lawsuit was filed in 2017 in Washington, D.C., but HCA is facing another 2017 lawsuit with similar claims in California, where a former HCA nurse claims that the government was billed for intensive care and other inpatient services when patients were still in the emergency room.
Updated with a statement from HCA Healthcare:
HCA Healthcare was not aware of these claims before the federal government decided not to participate and the court dismissed them. We have robust processes and oversight of our rehabilitation services, and we are disappointed Modern Healthcare has persisted with a misleading story detailing allegations that were dismissed before they filed their story.
Read the story here.