Medicare Compliance & Reimbursement

If this allegation can be proven, the government might not even have a false claims case. The American Hospital Association recently asked the federal government to review the appropriateness of its "kyphoplasty initiative," in which authorities are investigating hospitals that billed inpatient stays for Medicare patients who received the spinal procedure. In a September letter to the U.S. Attorney General and HHS Secretary, AHA notes that the kyphoplasty initiative originates from an FCA settlement involving a manufacturer of medical devices used in the surgical procedure to artificially restore collapsed vertebrae. The DOJ alleged in the investigations that "the manufacturer misled physicians and hospitals about the medical necessity of an inpatient hospital stay following a kyphoplasty, and the applicability of certain billing codes to the procedure and the inpatient stay," AHA states. AHA goes on to say that form letters being sent by the government to hospitals in the kyphoplasty initiative [...]