Feds accuse local hospitals of overcharging

December 12, 2011

Catholic Healthcare West paid $875,564 to the United States to settle allegations that certain of its affiliate hospitals, including French Hospital in San Luis Obispo and Arroyo Grande Community Hospital, overcharged Medicare during a period of almost a decade, United States Attorney Benjamin B. Wagner announced last week.

These settlements resolve findings that the hospitals overcharged the federal Medicare program through duplicating charges for certain services, duplicating billing for some procedures using different codes, and un-bundling packaged therapy services when the individual procedures should have been billed as a group.

Catholic Healthcare West is the fifth largest hospital provider in the nation and the largest hospital system in California.

U.S. Attorney Wagner said his office actively pursues the recovery of ill gotten Medicare dollars.

“This settlement not only recoups over payments made by Medicare, it helps ensure more accurate billing practices by these hospital systems in the future,” Wagner said.

The settlements are the result of investigations by the U.S. Department of Health and Human Services and the Office of Inspector General.


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19 Comments

  1. smartmouth says:

    10 years of over billing and less than a million dollars in settlement payments. Not really too bad when you think about it……………………..

    (1) 1 Total Votes - 1 up - 0 down
    • Typoqueen says:

      Actually, I was thinking the same thing when you consider the $ amount of the bills that get processed. % to $$, it’s probably not that much. This very well could just be screw ups not deliberate over billing. On the other hand they need to be held accountable for their screw ups and try to improve.

      (1) 1 Total Votes - 1 up - 0 down
  2. danika says:

    I just spent the Thanksgiving holiday (10 days in total) in a community hospital in Los Angeles, having undergone major surgery (what? you guys didn’t miss me???). I would like to say the hospital demanded NO up front monies, did not scan everything I came into contact with, and treated me with the up most respect and quality care. I have had experiences with French Hospital, Sierra Vista Hospital, and Twin Cities Community hospital and my level of care at VHH exceeded my expectations. Twin Cities does not have a good reputation and there is a reason for that. The hospitals named in this article should take a good hard look at what they are really about and learn from those that are truly in the business to “care” for those in need.

    (7) 7 Total Votes - 7 up - 0 down
    • Cindy says:

      “(what? you guys didn’t miss me???)”
      danika, I noticed that you weren’t around and I missed you ;) Sorry to hear you were so sick but glad to hear you received such excellent treatment. Hopefully all went well and 2012 will be an excellent year for you.

      As to all this hospital stuff, I’ve never been to the hospital and can’t make any comments or comparisons about the quality of care that they do or don’t offer. I do think that $875K in billing errors between 2002 – 2008 is a very small percentage of what they bill Medicare and I’m inclined to believe that it was done in error.

      (2) 2 Total Votes - 2 up - 0 down
      • brook says:

        Having been a patient, I’m more inclined to think that the $875k was all they could find and does not reflect what is actually over-billed.

        (4) 4 Total Votes - 4 up - 0 down
        • Cindy says:

          According to more detailed reports : “The probe centered on CHW activities from January 2002 to March 2008 on double billing Medicare for infusion therapies and treatments to break up kidney and bladder stones.”

          Sounds to me like they had a glitch in that area where there were extra codes set up in the billing system or something. I would expect to see random double billing otherwise, but that doesn’t seem to be the case?

          (3) 3 Total Votes - 3 up - 0 down
      • danika says:

        Thank you Cindy. I am getting better slowly, day by day.

        There is a clear and present love of money when you go to the hospital. The very first thing I was asked at Twin Cities Hospital was for my insurance card and my $500 E.R. deductible that would be waived if I were subsequently hospitalized. Did they wait to ask me after determining my need to be admitted? No! So I pulled out the money, right there in the exam room, and sure enough I was admitted 20 minutes later. It was the money they were after. I often wonder if I hadn’t paid there and then if I would have been admitted. A question I will ask myself for years to come.

        I have no love for hospitals. They are a necessary evil. But when you need them, they are priceless.

        (2) 2 Total Votes - 2 up - 0 down
        • Typoqueen says:

          Hey danika, I noticed that you were out of action for awhile. I just thought that you might have been taking a break from us. Now that you’re recouping you can post more and we get back to arguing.

          I’m sorry that you had to undergo surgery, that’s rough. I’m glad that you are back on the mend. It must have been pretty bad if you went to LA and if you were in for 10 days, they don’t keep people in for that long very often these days.

          You’re right about hospitals being a necessary evil.

          Glad you’re back.

          (0) 0 Total Votes - 0 up - 0 down
    • waterone says:

      I won’t argue the point that hospitals are a business and want to be paid for their services. However, over the past several years members of our family have been to Twin Cities for a number of procedures, some in the ER, some in the Outpatient Surgical Unit and some at the adjacent Templeton Surgery Center. We always found the nurses and doctors to be among the best that we have ever dealt with – in comparison with Sierra Vista where they “lost” me for a good hour while I was under post-op sedative. In any event, hopefully the hospitals caught in this latest issue will take note and change their practice of overcharging.

      (1) 1 Total Votes - 1 up - 0 down
    • smartmouth says:

      I missed you!

      (1) 1 Total Votes - 1 up - 0 down
  3. r0y says:

    Let’s not forget how often the government either refuses to pay (hospitals eat it) or pays below actual cost (hospital eats it). I’ve seen far too many examples of CHW waiving fees for people in need (board of Nuns and all that) than I’ve seen of government payments being timely, correct, or even there in some cases.

    Not saying CHW will be without sin, here, but I’ve not met a medical professional that has anything nice to say about Medicare or Medical in regards to reimbursements.

    (4) 4 Total Votes - 4 up - 0 down
  4. Ted Slanders says:

    But, but, the foundation of Catholic Healthcare West is in it’s name, “Catholic” which refers to our Christian God! What happened? “You shall not steal; you shall not deal falsely; you shall not lie to one another.” ( Leviticus 19:11) As if the Catholic pedophile Priests isn’t enough bad PR, here the Catholic French Hospital slaps Jesus in the face again!

    Why did they only investigate Medicare fraud? Case in point; in my last ER visit to French, I was only there for 3.5 hours, and it cost $8700.00! Okay, okay, I have to admit that they had to get their MRI specialist out of bed, and he did have to drive all the way from Morro B ay to come in at $850.00 for his services. Furthermore, after yawning and still waking up in my behalf, the 3 minute scan only cost $3700.00!!!

    The irony is that when I received my bill, with no healthcare insurance, it did state that if I paid immediately, that they would offer me a 50 percent discount! Huh? If they would be happy with this discounted amount then, then why not offer this “deal” at the onset of the bill?

    Their hospital costs give a whole new meaning to being “non-profit!”

    (9) 11 Total Votes - 10 up - 1 down
    • r0y says:

      How non-profit could they be if they didn’t have hundreds of thousands of pages of regulations, rules, etc.?

      Pretty hard to even have a lemonade stand in our country, let alone a large health care providing company.

      (3) 3 Total Votes - 3 up - 0 down
      • brook says:

        A hospital with no regulations? Actually they have very good data processing programs for billing – and an dedicated staff taking care of the business end.

        And don’t forget – if you’re properly connected in SLO, running a lemonade stand or anything else would be a snap.

        (2) 2 Total Votes - 2 up - 0 down
    • Vagabond says:

      Well, you have to remember that heath care pricing is tailored to the customer just like everything else.
      Who pays for the majority of heath care bills? Why their best customer of course, the insurance industry.
      If there was no insurance industry, and heath care providers had to rely on end users paying the bill what do you think would happen?
      Would there simply be no healthcare? Or would the pricing come into line with what people can pay?
      How in the world did we survive without insurance in the past?

      (2) 2 Total Votes - 2 up - 0 down
      • Ted Slanders says:

        The individuals that have healthcare insurance, basically pay for those that don’t with their high rates. I have to admit, the care that I received at French Hospital with my untimely stay, was great!

        (1) 1 Total Votes - 1 up - 0 down
  5. bobfromsanluis says:

    The more audits we have of Medicare providers, the more fraud and waste will be uncovered. Those who claim Medicare is in trouble seem to have no problem with those who commit the actual fraud; could it be because those violators donate heavily to campaign funding?

    (5) 11 Total Votes - 8 up - 3 down
    • r0y says:

      I agree. But why stop at the providers? Can we also audit the source? Think any sweet backroom deals, insider trades or other nefarious acts might befall the honorable folks who run Medicare? I’d be curious to find out.

      Is anything the government runs actually audited by a non-governmental agency? I really don’t know, in the end liars and cheats are liars and cheats, no matter where they are or what they do; they all bring society down.

      (3) 3 Total Votes - 3 up - 0 down
      • bobfromsanluis says:

        “Is anything the government runs actually audited by a non-governmental agency?” You really need to have auditors that don’t have a political axe to grind, nor be held in sway by a particular agency or political office; in other words, allow the auditors to do the best job they can without any expectation of what will be found. If fraud and waste are uncovered, report that so the situation can be changed; if no fraud or excessive waste is found, then move on to the next agency or program to be audited. The thing is, numbers, like facts, don’t have a political bent and are not exclusive property of one political party or the other. Neither party is free from corruption, but the auditors, IMO, do need to federal employees not private contractors. A public employee such as an auditor that has free rein to investigate without regard for who might be implicated by scandal is the best voice for the American public.

        (4) 4 Total Votes - 4 up - 0 down

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