The U.S. Department of Justice announced today that Shands Healthcare will pay $26 million to resolve allegations that its hospitals submitted false claims to Medicare, Medicaid and other federal health care programs.
The DOJ said in a release they received allegations that “hospitals knowingly submitted inpatient claims to Medicare, Medicaid and TRICARE for certain services and procedures that Shands Healthcare knew were correctly billable only as outpatient services or procedures.”
The alleged incidents took place from 2003 to 2008 at six Shands Healthcare locations: Shands at Jacksonville now known as UF Health Jacksonville; Shands at Gainesville, also known as Shands at the University of Florida; Shands Alachua General Hospital, Shands at Lakeshore, Shands Starke and Shands Live Oak.
The claims come as a result of the False Claims Act, which allows private citizens to sue on behalf of the government. Terry Myers filed the suit in the federal district court in Jacksonville April 30, 2008, according to Shands.
Shands says Myers was hired as an independent consultant to complete a routine audit of billing practices.
“We proactively initiated an independent audit that identified some opportunities to improve billing processes at Shands. We took immediate steps to make improvements.” said Timothy M. Goldfarb, CEO of Shands HealthCare in Gainesville.
A release from Shands said they have since trained their employees on new policies and procedures and began using improved software to ensure billing information is coded correctly.
Goldfarb said that audits of billing practices are a regular necessity to stay current with the evolving health care regulatory environment.
The settlement did not include an admission of liability from Shands but did ensure Florida will receive $829,600 and $25,170,400 will be returned to federal healthcare programs.
U.S. Department of Justice settlement with Shands Healthcare - 8/19/13
