Columbia state’s Medicare leader

Art Nadler

Monday, March 31, 1997 | 11:59 a.m.

When it comes to getting the most out of Medicare payments, Columbia Sunrise Hospital and Medical Center leads the state, a Nevada health care official has found.

Sunrise, as do many for-profit hospitals, runs sophisticated computer programs to achieve "revenue maximization" when seeking payment approval from Medicare, said Christopher Thompson, chief health care and financial analyst with the state Department of Human Resources.

Medicare pays set rates for treatments based on codes. The higher the code on a particular illness, the more money is paid. These hospital computer programs analyze a patient's illness and seek the highest code, Thompson said.

"Columbia Sunrise is the most sophisticated hospital," Thompson said. "It does run on average a higher case mix. Columbia has put more of an effort into revenue maximization."

The federal government is investigating whether Columbia/HCA Healthcare Corp. has been overbilling Medicare patients under a process called "upcoding."

"If we think it is just pushing the edges of what is appropriate, we'll get our money back," said Bruce Vladeck, chief Medicare administrator. "If there have been some false claims, we will refer it to federal investigators."

A New York Times story said that Columbia hospitals in Nevada, Florida, Texas, Illinois and Kentucky are being investigated.

"I know nothing about this. Locally, this has no implication at this point," said Ann Lynch, director of marketing and community relations at Sunrise. "I never heard of any of these activities."

Thompson said the state doesn't do reviews regarding upcoding. It's an issue, he said, between Medicare and hospitals.

"But we are extremely concerned of any issue that may relate to Medicare fraud," Thompson said.