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Oklahoma City-area hospitals agree to pay fines for filing inflated Medicare claims

OU Medical Center and OU Medical Center Edmond, along with 53 hospitals nationwide, will pay $34 million to settle lawsuit over billing for spinal procedure.
by Tim Willert Published: July 3, 2013

Two Oklahoma City-area hospitals accused of overcharging Medicare for a particular back procedure are among 55 hospitals nationwide that will pay $34 million to settle a lawsuit, the U.S. Department of Justice reported Tuesday.

OU Medical Center and OU Medical Center Edmond, along with 21 other hospitals managed by Nashville-based Hospital Corporation of America, will pay the government $7.1 million in fines for allegedly filing inflated claims for kyphoplasty, a procedure to treat compression fractures of the spine.

Federal prosecutors characterized the procedure as “minimally evasive,” and alleged the hospitals frequently billed Medicare for the procedure on an inpatient basis rather than an outpatient basis to increase their billings.

“Hospitals that participate in the Medicare program must bill for their services accurately and honestly,” prosecutor Stuart F. Delery said in a statement. “The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desires of medical providers to maximize profits.”

It is unclear how much each metro-area hospital agreed to pay. The settlement did not include a facility breakdown, HCA spokesman Ed Fishbough said.

“We are pleased to see new clarification of industry care standards, which help physicians make decisions regarding kyphoplasty patients, and we are confident as a result that this issue has been resolved,” Fishbough said in a statement.

The Justice Department has reached settlements with more than 100 hospitals totaling $75 million in fines to resolve similar allegations.

by Tim Willert
Education Reporter
Tim Willert is a native Californian with Oklahoma ties who covers education. Prior to moving to Oklahoma in June 2011, he was as an editor for in Century City, Calif., and reported on courts for the Los Angeles Daily Journal and...
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