News: HCA accused of fraudulently billing inpatient services for ED patients

CDI Strategies - Volume 13, Issue 9

A former Hospital Corporation of America (HCA) nurse accused the hospital chain of fraudulently billing the federal government for services at Regional Medical Center in San Jose, California, to inflate reimbursement.

According to an unsealed False Claims Act case from 2017, the whistleblower claimed that administrators billed intensive care unit, medical-surgical, and telemetry services on an inpatient basis when the patient was still in the ED, Modern Healthcare reported.

The issues stem from capacity and understaffing issues, according to a former ED nurse at Regional Medical Center. The facility takes on more patients than it can accommodate and hasn’t adequately trained its ED nurses in those specialties, according to the complaint.

The lawsuit claims that the ED typically holds twice as many patients as there are beds available and that management requires staff to tell other facilities that there is room for additional patients even when there isn’t. This is “done solely to increase billing,” Modern Healthcare reported.

At times, according to the suit, patients waiting for an inpatient bed could spend days in the ED, even though their submitted claims say they were already admitted. Though these patients were only treated by the ED staff, the charts indicate that ICU, medical-surgical, or telemetry staff provided services in inpatient beds that do not exist, according to Modern Healthcare.

According to the lawsuit, the fraudulent practices allegedly extend beyond the San Jose hospital to other HCA facilities. The federal and state governments have declined to intervene, and HCA said in a statement that the allegations are without merit.

Editor’s note: To read Modern Healthcare’s coverage of this story, click here. To read the unsealed case, click here. To read about other recent whistleblower cases, click here.

Found in Categories: 
Clinical & Coding, News, Regulations