DENVER, Colo. (KRDO) – University of Colorado Health (UCHealth) is agreeing to pay millions in settlement costs to resolve allegations that it filed false claims to federal health care programs.
According to a release from the U.S. Attorney's Office for the District of Colorado, UCHealth agreed to pay $23 million to settle claims it violated the False Claims Act by "falsely coding certain Evaluation & Management (E&M) claims submitted to the Medicare and TRICARE programs."
E&M claims relate to medical visits that involve evaluating and managing a patient’s health and medical conditions, including qualifying visits to a hospital’s emergency department.
According to the release, a hospital may use one of five different codes when submitting an E&M claim to Medicare or TRICARE, depending on the resources used during the patient's visit.
The government claims that from Nov. 1, 2017, through March 31, 2021, UCHealth hospitals automatically coded certain emergency room visit claims with the code corresponding to the highest resource usage, even when treatment didn't meet the requirements for billing Medicare and TRICARE.
“Improperly billing federal health care programs drains valuable government resources needed to provide medical care to millions of Americans,” said Principal Deputy Assistant Attorney General Brian M. Boynton in the release. “We will pursue health care providers that defraud the taxpayers by knowingly submitting inflated or unsupported claims.”...
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