Simi Valley (Calif.) Hospital and Health Care Services agreed to pay the federal government $3.6 million to settle allegations that it routinely billed Medicare for more complex cases of pneumonia, sepsis and kidney infections than was documented between 1993 and 1998. The 197-bed hospital, owned by Adventist Health, also signed a three-year corporate integrity agreement with HHS' inspector general's office. Simi Valley did not admit wrongdoing. The settlement stems from a national investigation of pneumonia upcoding begun by HHS in 2000 based on a whistle-blower lawsuit naming more than 100 hospitals. Most of the hospitals have since settled. Simi Valley was not among the hospitals named in the whistle-blower lawsuit. In a news release, the hospital said it decided "to avoid the inconvenience and expense of protracted litigation." The hospital also said it was increasing education for coding staff. -- by Mark Taylor
Calif. hospital to pay $3.6 million in upcoding case
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