Duke University Health System in Durham, N.C., has agreed to pay $1 million to resolve allegations that it fraudulently inflated its Medicare bills by unbundling some cardiac services and billing for physician assistants' time illegally.
The three-hospital system did not admit wrongdoing, but did cooperate with investigators after a former revenue-cycle employee filed a whistle-blower lawsuit against the system that included the allegations.
“Healthcare fraud like this wastes tax dollars, harms patients who need care, and drives up medical costs for all of us,” North Carolina Attorney General Roy Cooper said in a written statement. “We're working closely with federal officials to root out this kind of fraud in North Carolina and make wrongdoers pay.”
A statement from Duke officials said that no one at Duke had any intention of violating the law, and that the government healthcare program services implicated in the allegations did not violate anti-fraud laws.
“For settlement purposes only, we have agreed to pay back to the Medicare, Medicaid and Tricare programs payments received over a six-year period for claims that resulted from an undetected software problem and through possible misapplication of certain technical billing requirements,” according to the hospital's written statement.
Leslie Johnson, a former healthcare bill coder and quality-control auditor for Duke's revenue-cycle subsidiary, Duke Patient Revenue Management Organization, accused the system of violating the federal and North Carolina false claim acts, which make it illegal to intentionally submit inflated bills to government programs. Johnson, who now lives in New York, filed her lawsuit in December 2012.
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