Baptist Health Medical Center-North Little Rock has agreed to pay $2.7 million to settle claims that it improperly billed the federal Medicare program for some hospital stays in 2008 and 2009, federal officials said Friday.
The hospital entered the settlement agreement under the federal False Claims Act, Chris Thyer, U.S. attorney for the Eastern District of Arkansas, said in a news release.
The U.S. Department of Health and Human Services' Office of Inspector General contended that the hospital improperly billed for hospital stays lasting fewer than two nights each, Thyer said.
Federal officials contended that the hospital improperly converted patients' status from inpatient to outpatient, had standing orders to admit patients "without proper involvement of a physician" and gave improper orders for patients to be given inpatient status after scheduled outpatient procedures, according to the news release.
As part of the settlement, the hospital entered a five-year "corporate integrity agreement" requiring Baptist Health Medical Center-North Little Rock and Baptist Health Medical Center-Little Rock to be subject to independent annual claims reviews, Thyer said in the news release.
In an email, Baptist Health spokesman Mark Lowman said that about 550 claims were disputed -- less than seven-tenths of 1 percent of the claims submitted during the two years.
The allegations "centered around the federal government's reimbursement regulations for the decision about whether to admit an individual for hospital inpatient care or to provide observation services," Lowman said.
The health system did not admit any wrongdoing and agreed to the settlement "to avoid the inconvenience and expense of a protracted dispute with the federal government," Lowman said in the email.
"We have also agreed to work with the federal government to monitor our admissions policies and build on our existing and comprehensive compliance program of robust training, reporting and review protocols," he said.
Lowman added that the inspector general had suspended reviews of such claims and that national health care groups "claim the shifting and often ambiguous standards make it extremely difficult for physicians and hospitals to consistently comply with the regulations."
The Baptist Health system supports lawsuits by the American Hospital Association that contend the regulations are unlawfully arbitrary, could compromise seniors' medical care and deprive hospitals of proper reimbursement, the hospital spokesman said.
The hospital group and a coalition of its members filed at least two lawsuits in April arguing that the federal Centers for Medicare and Medicaid Services' "two midnight rule" burdens hospitals with "unlawful arbitrary standards and documentation requirements" and deprives them "of proper Medicare reimbursement for caring for patients," according to a news release at the time the suits were filed.
The coalition took issue with new federal rules that a physician must certify at the time a Medicare patient is admitted to the hospital that the patient is expected to need hospitalization for two days to be considered an inpatient, the news release said.
Metro on 02/28/2015