El Centro (Calif.) Regional Medical Center agreed to pay the United States $2.2 million to settle a whistle-blower lawsuit brought by its former director of health-information management. The suit alleges that the hospital billed Medicare for short-term admissions when the stays should have been coded as outpatient observations.
Calif. medical center to pay $2.2 million in whistle-blower suit
"It is an unfortunate error in reporting and was unintentional," CEO David Green said in a news release. The agreement with the U.S. Justice Department, which pertains to claims submitted from 2000-08, stipulates that the 165-bed hospital does not admit liability by settling the matter. “This settlement is a business decision by the hospital, as approved by the board of directors,” Green said.
Pietro Ingrande, who according to court documents was director of health-information management and privacy officer from 2002 to 2004, filed a complaint under seal in San Diego in 2006 alleging the hospital's billing practices violated the False Claims Act. The government formally joined the case in August. Under the terms of the agreement, Ingrande is set to receive $375,000 from the settlement payment.
El Centro Regional, which also agreed to enter a corporate-integrity agreement with HHS' inspector general's office, said in its news release that the hospital has modified its utilization review, coding documentation and billing processes.
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