Allegations that a Maryland hospital billed Medicare for ambulance services when it really wheeled patients around in a gurney are part of one of three recent fraudulent billing settlements between the federal government and healthcare providers.
In those settlements, the government collected a combined $1.1 million in civil monetary penalties from two hospitals and a surgery center.
St. Joseph Medical Center in Towson, Md., paid the largest fine of the three-$564,000. The former Riverside Hospital in Wilmington, Del., paid $472,492, and Everett (Wash.) Surgical Center, paid $50,000.
Under the settlements with HHS' inspector general's office, none of the three admitted to any violation of law.
MODERN HEALTHCARE*obtained copies of the settlements last week under the federal Freedom of Information Act. HHS' inspector general's office signed off on all three settlements in May.
In the first case, HHS accused St. Joseph of billing Medicare for round-trip ambulance service when the patients actually were taken by gurney around the hospital complex for diagnostic services.
The government investigated Medicare and Medicaid claims filed by St. Joseph from 1992 to 1995 for the reported ambulance services and concluded the hospital improperly billed Medicare $188,000.
The billing problems were a misunderstanding, said Linda Harder, a spokeswoman for the 460-bed hospital, which is now part of Denver-based Catholic Health Initiatives. She said the hospital was following state billing rules and didn't realize the claims didn't meet Medicare billing requirements.
"As soon as Medicare clarified it was not appropriate for us to bill, we promptly ceased billing," she said.
The settlement with HHS also requires the hospital to institute a "corporate integrity" plan to enhance its ability to comply with Medicare billing rules and avoid similar claims problems in the future.
During the time of the filings, St. Joseph had been part of Aston, Pa.-based Franciscan Health System. Franciscan and two other Roman Catholic systems formed CHI last year.
Meanwhile, HHS accused the former Riverside Hospital of a "persistent practice" of filing claims for medically unnecessary services and for services that weren't performed.
The government looked at the hospital's Medicare and Medicaid claims from September 1993 to March 1994.
HHS accused the hospital of a string of offenses, including overbilling for cardiac care, altering claims, "upcoding" and "unbundling" to maximize Medicare and Medicaid payments.
The 149-bed hospital, which has since closed, denied the government's allegations.
Now called Riverside Health Care Center, the former hospital is a long-term and outpatient-care center. Riverside had been an osteopathic hospital before it became part of Medical Center of Delaware in Wilmington almost two years ago, Medical Center spokeswoman Natalie Dyke said.
"We're responsible and committed to complying with all the state and federal billing," she said.
Medical Center of Delaware, a two-hospital private not-for-profit system, didn't own Riverside during the period the government investigated.
Finally, HHS accused Everett Surgical Center of submitting false claims to Medicare from January 1991 to March 1994.
"There was some confusion in billing," said Tom Graafstra, an attorney for the surgery center.
Graafstra said the disputed billing was for pain medication.
A compliance plan that included training in proper billing procedures was part of the settlement.