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    14 Hospitals Pay $12M to Settle Medicare Fraud Charges Surrounding Spinal Surgery Billing
    Arrangements follow federal government's continuing kyphoplasty investigations.




    Fourteen hospitals in 7 states have agreed to pay the federal government $12 million to settle charges of fraudulent Medicare billing for a type of spinal surgery.


    According to the U.S. Department of Justice, the following hospitals will share in the restitution for the latest round of settlements on this issue:


    Plainview Hospital, Plainview, N.Y.: $2.3 million
    North Mississippi Medical Center, Tupelo, Miss.: $1.9 million
    Mission Hospital, Asheville, N.C.: $1.5 million
    Wenatchee Valley Medical Center, Wenatchee, Wash.: $1.2 million
    Community Hospital Anderson, Anderson, Ind.: $501,000
    St. John's Mercy Hospital, Creve Coeur, Mo.: $365,000
    North Shore Syosset Hospital, Syosset, N.Y.: $193,000
    Gulf Coast Hospital, Fort Myers, Fla.: $173,000
    Lee Memorial Hospital, Fort Myers, Fla.: $160,000
    Cape Coral Hospital, Cape Coral, Fla.: $73,000
    Four Florida hospitals affiliated with Adventist Health System/Sunbelt, Inc., will jointly pay $3.9 million:


    Florida Hospital Orlando
    Florida Hospital-Oceanside
    Florida Hospital Fish Memorial
    Florida Hospital Heartland Medical Center


    As in previous settlement agreements, the hospitals were accused of performing kyphoplasties, spinal fracture repair procedures that are often performed on an outpatient basis, as inpatient cases in order to bill Medicare for higher reimbursements.


    More than 40 hospitals have paid $39 million to settle federal investigations into fraudulent kyphoplasty billing activities, which took place between 2000 and 2008, according to a published report.


    The investigations began in 2008 when former employees of a subsidiary of medical device manufacturer Medtronic Spine alerted the government that their company had been recommending the practice of converting outpatient kyphoplasties into inpatient cases for profit.


    That year, Medtronic signed a $75 million settlement with the Justice Department over the issue.
    Comments 3 Comments
    1. ethernaut's Avatar
      ethernaut -
      i know this response isn't about spinals, but surely about CMS "issues". at my main site, when i enter the OR, i document time in as it says on the clock, whether it be the 39th minute, the 17th minute, etc... and when i drop off in PACU, i record out time in similar fashion. billing then adjusts RVUs as deemed appropriate. and at the surgery center where i spend a lot of time, i still do this, but have noted that upon entering the OR, the nurse always rounds to the closest 5 or 0 minute. they say that their computers can't do it any other way, and that they've always done it like that. after i've spieled about how this type of recording can red flag the facility, and CMS can come knocking, they seem dumbfounded and unconcerned.

      a wise MDA once "tipped" me off to this some time ago, and i do my part to never be named in a 'fraud' suit wherever i practice. now, maybe i'm overreacting, but anyone else see this as a potential issue when noting in/out times?
    1. gaspass3's Avatar
      gaspass3 -
      Quote Originally Posted by ethernaut View Post
      i know this response isn't about spinals, but surely about CMS "issues". at my main site, when i enter the OR, i document time in as it says on the clock, whether it be the 39th minute, the 17th minute, etc... and when i drop off in PACU, i record out time in similar fashion. billing then adjusts RVUs as deemed appropriate. and at the surgery center where i spend a lot of time, i still do this, but have noted that upon entering the OR, the nurse always rounds to the closest 5 or 0 minute. they say that their computers can't do it any other way, and that they've always done it like that. after i've spieled about how this type of recording can red flag the facility, and CMS can come knocking, they seem dumbfounded and unconcerned.

      a wise MDA once "tipped" me off to this some time ago, and i do my part to never be named in a 'fraud' suit wherever i practice. now, maybe i'm overreacting, but anyone else see this as a potential issue when noting in/out times?
      I agree. Completely. We have to be doing everything we do twice as well and twice as accurate to be considered half as good. Why cut corners at all?
    1. MmacFN's Avatar
      MmacFN -
      We have had this discussion in the past with the hospital.

      If CMS decided to audit they look at every phase.

      Pre-Op times from when the pt arrived.

      PACU time patient arrives

      Anesthesia start times, surgery start times, end times as well as arrival in PACU time as compared with the OR Circulator records, PACU records and Pre op records.

      If any of these numbers do not match (specifically yours, circulator & PACU) there will be an investigation. The result of which would be unknown. However, you can bet if YOUR numbers show more time than the others do it will fall on anesthesia.

      All numbers should match up so i dont give times anymore i just ask the circulator for 'in time' 'surgery start time', 'surgery end time' and leave room/pacu time'.

      Quote Originally Posted by ethernaut View Post
      i know this response isn't about spinals, but surely about CMS "issues". at my main site, when i enter the OR, i document time in as it says on the clock, whether it be the 39th minute, the 17th minute, etc... and when i drop off in PACU, i record out time in similar fashion. billing then adjusts RVUs as deemed appropriate. and at the surgery center where i spend a lot of time, i still do this, but have noted that upon entering the OR, the nurse always rounds to the closest 5 or 0 minute. they say that their computers can't do it any other way, and that they've always done it like that. after i've spieled about how this type of recording can red flag the facility, and CMS can come knocking, they seem dumbfounded and unconcerned.

      a wise MDA once "tipped" me off to this some time ago, and i do my part to never be named in a 'fraud' suit wherever i practice. now, maybe i'm overreacting, but anyone else see this as a potential issue when noting in/out times?
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