Four hospitals recently paid a total of more than $1.25 million to settle pneumonia upcoding allegations, Modern Healthcare has learned. The hospitals, which did not admit wrongdoing, allegedly falsely billed Medicare for treating pneumonia patients as though they had a more severe form of the disease than they actually did to obtain higher reimbursements. The alleged misconduct took place from 1994 to 1998. Hospitals settling included: 188-bed Kershaw County Medical Center, Camden, S.C., paid $200,000; 529-bed Community Medical Center, Toms River, N.J., paid $516,000; 219-bed St. Luke Hospital East, Fort Thomas, Ky., paid $275,000; and 80-bed Petaluma (Calif.) Valley Hospital paid $262,000. Kershaw County and St. Luke did not sign corporate integrity agreements, but Community signed a three-year corporate integrity agreement and Petaluma signed a three-year certificate-of-compliance agreement. St. Luke's spokeswoman Amy Stricker said the hospital relied on expert advice from a consultant and cooperated fully with the government's investigation once it learned that the advice was suspect. Spokespersons for the other two hospitals could not be reached at deadline. -- by Mark Taylor
Hospitals pay to settle upcoding allegations
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