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As expected, the Department of Justice (DOJ) has begun notifying hospitals outside of Pennsylvania that they owe money to the government for Medicare billing errors involving the 72-hour payment window. At issue are costs billed to Medicare for outpatient services that should have been included in the inpatient bill because the services were rendered within 72 hours of an admission. DOJ considers the errors violations of the False Claims Act.

The settlement agreement that the DOJ is offering hospitals bases the amount of the fines on a formula in which the number of erroneous claims submitted by a hospital is compared with the number of erroneous claims submitted by all other hospitals in the same area. This comparison then is adjusted "to account for the effects that hospital size might have on the data utilized." The agreement also outlines the steps a hospital must take to avoid future billing error liability. A key component of the compliance program is that hospitals must create and offer an annual instruction program that all hospital billing office personnel must attend.

The U.S. Attorney's Office in the Middle District of Pennsylvania, which initiated the investigation of Pennsylvania hospitals, is attempting to retain jurisdiction for this issue throughout the country and is working with many other attorney's offices nationwide. Hospitals in Mississippi already have received letters from the U.S. Attorney's office for the Northern District of Mississippi informing them that the hospitals "will be contacted directly by representatives of the U.S. Attorney of the Middle District of Pennsylvania who will be supplying you with the details of the claim against you." In concluding, the letter states that both offices hope the hospital will agree to the settlement; "however, should court action be required, our two districts will cooperate in that undertaking."

Not all U.S. Attorney's offices are willing to give up control of the case, however. The U.S. Attorney in Massachusetts has decided to pursue the case independently and has not granted jurisdiction to the U.S. Attorney from the Middle District of Pennsylvania. The U.S. Attorney in Massachusetts acknowledges that some hospitals may have paid back some of the duplicate payments, but the repayment "has not extinguished the hospital's potential liability for damage and penalties under the False Claims Act."

# posted by Medical Information : 4:41 AM