The Colorado US Attorney’s Office says UCHealth has agreed to pay $23 million dollars to settle allegations of fraudulent billing for emergency department visits. The hospital system, which is one of the largest health care providers in the state, released a statement denying the allegations and saying they agreed to pay to avoid a lengthy and costly litigation.
However, the US Attorney’s Office says UCHealth violated the False Claims Act by improperly coding certain medical claims submitted to federal health care programs, including Medicare and TRICARE. The allegations accuse the hospital chain of automatically coding certain emergency department visits as the most serious based on how long a patient was there and how many times health care providers checked the patient’s vital signs.
In a statement, the US Attorney’s Office wrote that UCHealth knew the automatic coding did not meet federal billing requirements.
“Fraudulent billing by health care companies undermines Medicare and other federal health care programs that are vital to many Coloradans,” said Acting U.S. Attorney Matt Kirsch for the District of Colorado in a statement. “We will hold accountable health care companies who adopt automatic coding practices that lead to unnecessary and improper billing.”
The allegations first came to light from a whistleblower lawsuit, filed by Timothy Sanders. The False Claims Act allows private citizens to sue on behalf of the government and receive a portion of what’s recovered from the settlement. Sanders will now receive $3.91 million as part of the settlement.
Besides the money owed, UCHealth is now expected to review and modify its billing practices to ensure future compliance with the law.
