Health care organization agrees to fine of $475,000.
SSM Health Care of Oklahoma, Inc. (“SSM”), who owns and operates St. Anthony Hospital in Oklahoma City, Oklahoma, has agreed to pay $475,000 to the United States to settle civil claims relating to SSM’s billing Medicare for inpatient services that should have been billed as outpatient services, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma.
The United States alleged that from Feb. 1, 2007, through Feb.28, 2009, SSM billed Medicare for inpatient services that should have been billed as outpatient services which resulted in higher reimbursements to SSM.
Specifically, it was alleged that individuals who presented at the emergency room, and patients who were scheduled for planned medical procedures, were admitted into the hospital and the services billed on an inpatient basis when they should have been billed on an outpatient basis.
The United States alleged that potential liability existed for SSM under the False Claims Act, the Civil Monetary Penalties Law, the Program Fraud Civil remedies Act, and common law.
In order to resolve these claims, SSM agreed to pay $475,000 to the government. In reaching this settlement, SSM did not admit liability, and the government did not make any concession regarding the legitimacy of the claims. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty involved in litigating the case.
This case was investigated by the United States Department of Health and Human Services Office of Inspector General and was prosecuted by Assistant United States Attorney Ronald R. Gallegos.