Three hospitals earlier this month became the latest to settle civil allegations of pneumonia upcoding in a nationwide probe that has so far garnered the government more than $30 million in recoveries.
Newton-Wellesley Hospital, a 228-bed hospital in Newton Lower Falls, Mass., paid the largest of the three civil monetary penalties, shelling out $3.3 million to settle allegations that it upcoded diagnoses for pneumonia and other conditions from 1992 to 1997 to increase Medicare reimbursements. The hospital, owned by Boston-based Partners HealthCare System, paid $2.78 million for upcoding pneumonia diagnoses and another $562,201 after it told the government that it had upcoded from 1995 to 2000 for septicemia, a blood infection.
Bradley Memorial Hospital, Cleveland, Tenn., and Massillon (Ohio) Community Hospital agreed to pay $1.79 million and $945,000, respectively, to settle pneumonia upcoding allegations.
None of the three hospitals admitted wrongdoing.
Meanwhile, a national investigation of hospital billing for Medicare laboratory tests-known as the Metzinger probe after a "billing-enhancement" consulting firm-has netted three more hospitals, which also signed three-year corporate integrity agreements and settled without admitting wrongdoing.
Under the agreements, 400-bed Conemaugh Memorial Medical Center, Johnstown, Pa., will pay $575,000; 125-bed Charles Cole Memorial Hospital, Coudersport, Pa., will pay $210,000; and 172-bed St. Elizabeth Medical Center in Utica, N.Y., will pay $227,000. Forty-one hospitals have settled allegations under the Metzinger probe for a total of more than $13 million.
In addition, the St. Petersburg (Fla.) Times has reported that the University of Florida and the government are negotiating an $8.6 million settlement of allegations that faculty physicians improperly billed federal and state healthcare programs for services provided by residents.