Hospitals Settle Fraud Claims
MARION -- The parent company of Heartland Regional Medical Center and dozens of other hospitals across the country will pay nearly $100 million to settle claims of defrauding Medicare and Medicaid.
A former employee at the Marion hospital filed the claims against Community Health Systems. That lead to an investigation by the U.S. Department of Justice.
The government alleges 119 CHS hospitals nationwide, including four in Southern Illinois, submitted fraudulent claims involving Medicare, Medicaid, and TRICARE patients from 2005 to 2010.
"The personnel that were doing the admitting had to justify to the management why a medicare patient, and keep in mind this was just the Medicare patients this wasn't the private pay patients, why a Medicare patient wasn't admitted instead of why was it necessary to admit them," said Marion lawyer Ronald Osman.
The employee alleges CHS hospitals admitted ER patients to the hospital even though it wasn't medically necessary, had a corporate policy requiring it, and placed quotas on hospitals for those Medicare and Medicaid admissions., all to increase reimbursements
As part of the agreement, the government will also be allowed to monitor the organization closely in the coming months to make sure they are complying with policies and procedures.
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