DOJ Helping Disgruntled Employees Shake Down Greenville Memorial Hospital?

The Department of Justice is claiming that GHS was overcharging medicare for a minimally invasive spinal injury treatment known as Kyphoplasty. On the word of two whistle blowers the DOJ came after GHS:

But the GHS did release a statement explaining why they didn’t fight what they are still calling false charges:

“Greenville Hospital System University Medical Center (GHS) has finalized a settlement with the U.S. Attorney’s Office Western District of New York regarding billing of kyphoplasty procedures performed at GHS hospitals from 2000 through 2008. Kyphoplasty is a minimally-invasive spinal surgery procedure used to treat painful, progressive vertebral compression fractures. Generally, in the past, kyphoplasty has been performed on an inpatient basis, but it can be performed on an outpatient basis in low risk patients. The U.S. Attorney’s Office is not alleging that any of the kyphoplasty procedures were inappropriately done, only that some could have been done on an outpatient basis. The settlement is based on the difference between higher inpatient reimbursement and lower outpatient reimbursement.

GHS cooperated fully with the government in this investigation of hospitals across the country. Prior to agreeing to the settlement, GHS conducted an internal investigation regarding allegations made by the U.S. Attorney’s Office. GHS’ internal investigation revealed that there was no intention of fraudulent billing by GHS and there was no attempt by GHS officials to influence physicians to perform kyphoplasty on an inpatient basis. Furthermore, GHS physicians made no additional money based on the location of services, and GHS physicians used their best clinical judgment and prevailing medical literature to make decisions to admit patients for optimal safety when performing kyphoplasty.

GHS has admitted no liability in this matter and we settled with the government to avoid the further costs of litigating this case. This investigation focused on the sufficiency of documentation in the medical records for these procedures. There were no concerns about the medical necessity of the kyphoplasty procedures itself. GHS has taken steps to ensure that appropriate documentation is present in the medical record for these procedures going forward.”

GHS is settling for $1,026,764.01. Here’s the kicker.

Whistleblowers in the case, will receive a total of $1.1 million as their share of the settlement, under the False Claims Act of 2008.

That figure is for all the whistle blowers in the 18 other settlements but we assume these two whistle blowers are making a good five figures at least. Almost seems like an incentive to lie, know what I mean?

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