Healthcare Business News

Regional News/South: Duke agrees to pay $1 million to settle whistle-blower lawsuit, and other news

By Joe Carlson and Associated Press
Posted: March 29, 2014 - 12:01 am ET

Duke University Health System in Durham, N.C., has agreed to pay $1 million to resolve allegations that it fraudulently inflated its Medicare bills by unbundling some cardiac services and billing for physician assistants' time illegally.

The three-hospital system did not admit wrongdoing, but did cooperate with investigators after a former revenue-cycle employee filed a whistle-blower lawsuit against the system that included the allegations.

“Healthcare fraud like this wastes tax dollars, harms patients who need care, and drives up medical costs for all of us,” North Carolina Attorney General Roy Cooper said in a written statement. “We're working closely with federal officials to root out this kind of fraud in North Carolina and make wrongdoers pay.”

A statement from Duke officials said that no one at Duke had any intention of violating the law, and that the government healthcare program services implicated in the allegations did not violate anti-fraud laws.

“For settlement purposes only, we have agreed to pay back to the Medicare, Medicaid and Tricare programs payments received over a six-year period for claims that resulted from an undetected software problem and through possible misapplication of certain technical billing requirements,” according to the hospital's written statement.

Leslie Johnson, a former healthcare bill coder and quality-control auditor for Duke's revenue-cycle subsidiary, Duke Patient Revenue Management Organization, accused the system of violating the federal and North Carolina false claim acts, which make it illegal to intentionally submit inflated bills to government programs. Johnson, who now lives in New York, filed her lawsuit in December 2012.

Follow Joe Carlson on Twitter: @MHJCarlson

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Fla. overcomes barriers to enroll the uninsured

Florida's Republican leaders have fought the Patient Protection and Affordable Care Act at every turn, banning navigators from county health departments, offering no state dollars to boost outreach efforts to 3.5 million uninsured, and leading the fight to repeal the law. Yet the state has emerged as a tale of what went right with President Barack Obama's healthcare overhaul.

More than 440,000 Florida residents had been enrolled through the federal marketplace through the end of February, putting Florida on pace to exceed the federal government's initial projections by the time enrollment closes March 31.

The numbers are impressive for a state where Republicans control the governor's mansion and both houses of the Legislature. By comparison, Republican-leaning Texas has enrolled 295,000 through the federal site, even though its population is about a third larger than Florida's.

Florida's success is due partly to infrastructure created in the swing state by Democratic-affiliated groups during the last three presidential elections. Also contributing is continued investment by the Obama administration and not-for-profit advocacy groups in the diverse state that will likely be competitive in November's midterm election.

Groups helping customers enroll in ACA-related health plans have used many of the same people who ran Obama's presidential campaigns, giving them five years of deeply entrenched relationships in communities, data to pinpoint the uninsured and veteran volunteers to track them down.

The successes and failures of the ACA also carry more political weight in a battleground state such as Florida where the new law will fuel election campaigns for Republicans and Democrats, said Democratic strategist Screven Watson.

The Republicans “are going to use Obamacare as a hammer over the Democratic candidates in November,” he said, adding that if Florida's enrollment numbers were dismal, it could have big implications in 2016.

Florida's Republican leaders chose not to spend any state money marketing the new health plans to millions of uninsured, so the work was supported by $20.5 million in federal grants plus manpower from the not-for-profit organization Enroll America. —Associated Press

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