Hospital In Trouble for Medicare Fraud

Friday, March 16th 2001, 12:00 am
By: News On 6

WASHINGTON (AP) -The Justice Department says a giant hospital chain that settled a Medicare fraud claim last year still owes the government money. Lawyers for whistle-blowers who filed the original complaint put the sum at more than $400 million.

HCA-The Healthcare Co., the nation's largest for-profit hospital chain, agreed in December to plead guilty to defrauding government health care programs and to pay more than $840 million in criminal fines, civil penalties and damages.

The Justice Department, in a filing in U.S. District Court here Friday, said it is still active in eight of 30 whistle-blower suits brought against the Tennessee company. The department contends the company cheated Medicare out of an unspecified amount of false claims.

The company was accused of inflating health care costs to get higher payments from Medicare, a federal health insurance program serving 39 million elderly and disabled Americans.

Lawyers at Phillips & Cohen, a Washington firm representing the whistle-blowers, said Thursday the company set aside reserves totaling more than $400 million from 1987 to 1992 to cover claims that it knew were not allowed under Medicare reimbursement regulations.

Neither Justice Department spokesman Charles Miller nor Jeff Prescott, a spokesman for HCA, would confirm the $400 million figure.

In a statement issued Friday, HCA said, ``These actions do not introduce any new suits or new legal theories.''

The case stemmed from a seven-year federal investigation triggered by private whistle-blowers. The December settlement was the largest government health care fraud settlement ever negotiated by the Justice Department.

The company was also accused of:
-Filing claims and getting reimbursed for marketing and advertising by mischaracterizing the cost.

-Billing Medicare for idle space in hospitals by claiming it was being used for patient care.

-Hiding overcharges and Medicare auditing errors that favored HCA facilities.

-Failing to implement Medicare audit adjustments and continuing to claim costs that had been previously disallowed.

-Shifting costs to home health care and other facilities that Medicare reimbursed at a higher rate.