Yet another civil whistleblower fraud lawsuit against Columbia/HCA Healthcare Corp. has been unsealed. The government has not decided whether it will join the suit.
Tonya Atchison, a former internal auditor at Columbia's national headquarters in Nashville, filed the suit in April 1997 in U.S. District Court in El Paso, Texas. It was only recently unsealed.
Sources said it's the eighth of 26 whistleblower lawsuits against the healthcare giant to have been unsealed. The federal government has intervened in five of those eight.
Atchison charged that Columbia, some of its affiliates and physician groups in west Texas, and other Columbia nursing and physician groups defrauded Medicare by:
* Violating Medicare's 72-hour rule, which requires hospitals to use only inpatient billing to charge for tests performed within 72 hours of a patient's admission to the hospital.
* Shifting costs from Medical Center West to Medical Center East, both in El Paso, on a 1995 cost report.
* Improperly claiming and inflating bad debt to increase reimbursements.
* Upcoding, or billing at a higher level of reimbursement than treatment warranted, and "unbundling," or inappropriate billing for combined services.
* Offering discounts to "cash upfront" payers without offering similar discounts to Medicare patients.
* Billing for the same tests that were administered unnecessarily multiple times.
The suit also charges Columbia with defrauding Medicare through its home healthcare and nursing home services.
"Atchison doesn't raise any new issues," Columbia spokesman Jeff Prescott said. "It simply includes all of the existing allegations."
Columbia and the U.S. Justice Department last month filed a motion asking a special federal judicial panel in Washington to consolidate the whistleblower suits into one case to facilitate a single global settlement (Aug. 30, p. 6). The motion is pending.