Twin City Hospitals Accused of Overcharging

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  • June 1, 2009
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Three Minnesota hospitals have agreed to pay the federal government $2.28 million to settle allegations that they overcharged Medicare during a five-year period.

The Minneapolis-St. Paul hospitals previously paid $1.45 million after determining through a self-audit they had overbilled Medicare for the claims. HealthEast Care System, the hospitals’ owner, said that after they became aware of the government’s concerns in June 2007, the company took immediate action to investigate its practices.
The federal agency accuses HealthEast of overcharging kyphoplasties from 2002 to 2007. The procedures, which the federal department said are often performed on an outpatient basis to correct osteoporosis-caused spinal fractures, were allegedly billed at inpatient status to increase the hospitals’ Medicare billings.
For more information, read the full report on the Star Tribune Web site.

Certified Inpatient Coder CIC

No Responses to “Twin City Hospitals Accused of Overcharging”

  1. Collene says:

    I have a question and it may not pertain to the above exactly. I work for an orthopaedic specialty practice and we have one hospital facility that one of our surgeons sees his patients out of. We have had several patients call us to tell us that they are receiving a bill for the hospital as well as our physicians fee. I have tried to reach the hospital to see what procedure code they are billing with but they will not give it to me or the patient who called as well?
    If you could clarify whether this is correct, for them to receive both a facility charge as well as a physician fee, because I am confused as well as our patients whether they should really have to pay for both?
    Thank you,
    Billing Dept.

  2. Brenda Clements says:

    In my experience if the patient is being seen in the hopsital setting then they can charge a facility fee for the use of the room. You may want to speak to your doctor and see if they have a special arrangement for this or not.

  3. Jan says:

    It will depend on what your providers agreement with the hospital is. If it is a facility based clinic then the facility can bill a facility fee. However, if your doc is leasing space as an independent office then the facility should not be billing a separate fee.

  4. deb says:

    When a Physicians has a hospital facility and works out of that facility the hospital can charge a facility charge, only and the physician bills the prof charge. The codes the hospital is on a UB92 form and is not the same as the Physicians form this is ok to do. The facility can only bill the facility charge, not the physicians fees

  5. Susan says:

    Hospitals charge for the use of their facility, staff and supplies. If your surgeon is providing office visits, the hospital will report E/M codes but they do not follow the same E/M guidelines as physicians. If your surgeon is performing a procedure on an outpatient, the hospital will submit a claim using the same CPT codes as the surgeon for the most part. They will additionally bill for supplies, labs, radiological exams and other services provided by their staff regardless of whether or not your provider supplied the professional component of the service. If the surgery is performed on an inpatient, the hospital will still submit a claim, however the claim will not contain any CPT codes. Inpatient claims have ICD-9 procedure codes. Your patient can also expect a separate bill from Anesthesiologists and Radiologists if those services were provided.

  6. Tricia Bergen says:

    Can a hospital use an E/M code, I thought those were to be used by physicians only? So, let’s say a patient went to the Emergency Room, the ortho MD who treated the patient for a fractured ankle, bills for an E/M code, and a procedure code (but didn’t actually do anything but order the x-rays) and then ordered a splint/half cast.
    Can the hospital also bill for an E/M?