UMC to pay $725,000 over Medicare billing

Thursday, May 2, 2002 | 9:56 a.m.

University Medical Center has agreed to pay the federal government a $725,000 settlement to resolve allegations of improper Medicare billing practices for pneumonia cases last year.

The settlement brings to $1,163,488 the amount the hospital has agreed to pay to settle 2001-related fraud allegations by the government. The other $438,000 is what UMC paid the government for pneumonia claims that UMC determined had been reimbursed at a higher level than what was due, the hospital said.

The hospital denies it committed any crimes, saying it erred in determining which type of pneumonia it should have billed for some Medicare patients.

UMC filed a number of pneumonia claims under the code for "caused by other specific bacteria" -- which returned a higher amount of money.

The government says UMC should have filed the claims under one of the more than 30 other codes for pneumonia, which would have returned lesser reimbursements.

"UMC has cooperated fully with federal investigators and has provided them with access to all documents required," UMC Chief Executive Office William Hale said. "We have been aggressive in our corporate compliance efforts and will continue to do so."

UMC, which had $47 million in fiscal revenues last year, received $6.7 million from the government in 2001 as reimbursement for underpaying the hospital for treating Medicare patients from 1993-95.

Repayment of the pneumonia overpayments still leaves UMC on the plus side of the government's reimbursements by more than $5 million for 2001, the hospital said.

Nearly 5,000 hospitals nationwide have been targeted for review of Medicare billing practices.