Nine hospitals settle kyphoplasty False Claims Act allegations

by Ben Vernia | May 17th, 2010

On May 17, the Department of Justice announced that the United States Attorney for the Western District of New York had entered into settlements with nine hospitals in seven states concerning kyphoplasty claims to Medicare. According to the announcement:

The settlements resolve allegations that the hospitals overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. In many cases, the procedure can be performed safely as a less costly out-patient procedure, but the government contends that the hospitals performed the procedure on an in-patient basis in order to increase their Medicare billings.

The settling facilities and the amount being paid by each to the United States are Ball Memorial Hospital, Muncie, Ind. ($1,995,431); Bethesda Memorial Hospital, Boynton Beach, Fla. ($356,079); Bloomington Hospital, Bloomington, Ind. ($1,443,848); Genesys Regional Medical Center, Grand Blanc, Mich. ($931,742); Huntsville Hospital, dba The Health Care Authority of the City of Huntsville, Huntsville, Ala. ($1,992,756); Palmetto Health dba Palmetto Health Baptist Hospital, Columbia, S.C. ($1,861,083.14); St. Elizabeth Medical Center, Utica, N.Y. ($195,976); St. Mary’s of Michigan Hospital, Saginaw, Mich. ($260,065.21); and United Hospital, St. Paul, Minn. ($428,656).

The settlements follow settlements in 2009 with nine other hospitals, and in 2008 with Medtronic Spine LLC, the successor to Kyphon, Inc. The case was brought by two qui tam whistleblowers, who will receive approximately $1.5 million of the $9.4 million recovery (a relator’s share of approximately 16%).

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