When HHS' inspector general's office says you're off the hook, get another opinion. Fletcher Allen Health Care at the University of Vermont in Burlington learned that the hard way.
In 1997, the inspector general dropped it from a list of facilities to be investigated by Physicians at Teaching Hospitals, a national probe into the Medicare billing of physicians at academic medical centers.
The hospital was one of 16 released from the investigation because of HCFA's unclear reimbursement guidance (Feb. 9, 1998, p. 6).
But Fletcher Allen's troubles were not over. The hospital paid $3 million in September to settle allegations of Medicare and Medicaid fraud (Sept. 20, p. 4).
Co-defendants in the case-Robert Dunn and his billing company, Associates in Practice Management, as well as Anesthesia Associates of Burlington, which provided anesthesiology services at Fletcher Allen-paid a total of $400,000.
The allegations stemmed from a whistleblower suit filed by Thomas Poulton, M.D., former head of the hospital's anesthesiology department and former president of Anesthesia Associates.
Poulton, who left the hospital in June, filed the suit in 1997, according to his lawyer, Marc Raspanti of Miller, Alfano & Raspanti in Philadelphia.
The state of Vermont and the federal government intervened in the case.
Poulton accused Fletcher Allen of actions similar to those typically involved in PATH investigations. He alleged the defendants:
* Billed for work performed by resident physicians using the names of attending doctors who were not present for the procedures.
* Upcoded, or billed for higher reimbursement than the treatment warranted, for surgical intensive care.
* Billed for nutrition consultations performed by nonphysicians using the names of doctors.
"These allegations relate only to documentation and billing issues, not to patient-care issues," said Fletcher Allen Chief Executive Officer William Boettcher in a written statement.
The settlement does not represent an admission of wrongdoing, he said. "We have chosen to settle this lawsuit to allow Fletcher Allen to avoid potentially costly and protracted litigation." Other hospitals dropped from the PATH initiative could still face charges such as those against Fletcher Allen, according to a spokeswoman from the inspector general's office.
Leonard Homer, a healthcare lawyer in the Baltimore office of Ober, Kaler, Grimes & Shriver, said that although the government may have walked away from the PATH cases, it cannot stop whistleblowers from filing similar charges.
He said most hospitals wouldn't "take the chance to litigate, given the multitude of claims filed. . . and the potential millions in damages they could face under the False Claims Act."
Six other hospitals have settled PATH allegations with the inspector general's office for about $75 million since the investigations began in 1995.