Wyoming Valley Health Care System, Wilkes-Barre, Pa., has settled allegations of laboratory Medicare billing fraud with the office of HHS' inspector general. The two-hospital, 442-bed system will pay $600,000, twice its alleged gain, without admitting legal guilt. The case is part of a national probe of hospitals that followed questionable advice on maximizing reimbursement from a former healthcare consultant. Wyoming Valley owns Nesbitt Memorial Hospital, the first facility to self-report overpayments in the probe, and Wilkes-Barre General Hospital.
An intermediate-care facility for the mentally retarded in Houston has reached a $1 million settlement over quality-of-care issues with the state of Texas. The facility, doing business under the name Appleridge Group Home, is a subsidiary of ResCare, Louisville, Ky. The settlement is the state's largest to date against a long-term-care facility. ResCare is the nation's largest provider of services to people with mental retardation and developmental disabilities.
HHS' inspector general recently released a final audit that said an Illinois hospital had falsely billed for nearly $2 million in unallowable costs for outpatient psychiatric services in its partial-hospitalization program. The audit revealed that in a 15-month period ended in November 1997, 186-bed Provena Saint Joseph Hospital in Elgin, Ill., billed $1.9 million for services that were medically unnecessary or undocumented. The report also identified another $97,494 in unallowable costs for meals and transportation. The report recommended repayment. In a written statement, Provena said Medicare paid the hospital only $1 million, disallowing $900,000 in billed charges. The hospital has requested a meeting with HCFA to resolve the dispute.
A Quorum Health Resources-leased hospital has agreed to pay $700,000 to resolve allegations that it billed for services by a provider excluded from state and federal health insurance programs. Cushing (Okla.) Regional Hospital, a 75-bed public hospital, billed Medicaid for claims from psychiatrist Lawrence Trombka, M.D., between February 1993 and December 1994, for inpatient chemical dependency and psychiatric services. Trombka, who was excluded from Medicare and Medicaid, was employed by Health Net but performed the services at Cushing.