Florida hospitals pay $26 million to settle false inpatient allegations

by Ben Vernia | August 20th, 2013

On August 20, the Department of Justice announced that a Florida hospital network had settled a whistleblower’s suit which alleged that the company false billed for inpatient hospital stays that were more appropriately charged as outpatient procedures. According to DOJ’s press release:

Shands Teaching Hospital & Clinics Inc., Shands Jacksonville Medical Center Inc. and Shands Jacksonville Healthcare Inc. (collectively, Shands Healthcare), which operates a network of health care providers in Florida, will pay the government and the state of Florida a total of $26 million to settle allegations that six of its health care facilities submitted false claims to Medicare, Medicaid and other federal health care programs for inpatient procedures that should have been billed as outpatient services, the Justice Department announced today. The six Florida hospitals are: Shands at Jacksonville; Shands at Gainesville, also known as Shands at the University of Florida; Shands Alachua General Hospital; Shands at Lakeshore; Shands Starke and Shands Live Oak.
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Allegedly, from 2003 through 2008, the six hospitals knowingly submitted inpatient claims to Medicare, Medicaid and TRICARE for certain services and procedures that Shands Healthcare knew were correctly billable only as outpatient services or procedures.

The case was orginally brought as a qui tam suit by the president of a healthcare consulting firm. The government announced that the federal share of the recover was $25,170,400, with the remainder going to the state of Florida under its False Claims Act. The government wrote that the relator’s share of those amounts had yet to be determined.

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