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Imperial Valley hospital pays $2.2 million to settle Medicare fraud allegation

The El Centro Regional Medical Center in Imperial County has paid $2.2 million to settle a civil action alleging that it defrauded the Medicare program, officials at the hospital and the Department of Justice said Monday.

The allegation was levied by a former employee of the hospital. Under the federal "whistleblower" provision, the former employee, Pietro Ingrande, will receive $375,000 from the settlement amount.

"We are committed to helping preserve the (Medicare) system's integrity by vigorously pursuing those who attempt to steal the funds that help keep our fellow Americans in good health," said Keith Slotter, special agent in charge of the FBI"s San Diego office.

David Green, chief executive of the 156-bed hospital, which is owned by the city of El Centro, attributed the incorrect billing not to attempted fraud but to lack of clarity in Medicare rules involving the distinction between outpatient care and in-patient treatment. Hospitals receive higher reimbursement for the latter.

"It is an unfortunate error in reporting and was unintentional," Green said, adding that changes have been made in the hospital's billing process.

Under the settlement, the hospital remains eligible for Medicare reimbursement but was required to sign a "corporate integrity agreement" involving review of how federal money is spent on healthcare.

The actual amount of the overbilling was not disclosed. Under federal rules for Medicare, hospitals caught overbilling can be charged up to three times the amount of the overcharge.

-- Tony Perry in San Diego

 
Comments () | Archives (2)

Subract the whistle blower fee from the award and you get a handsome payoff to the Department of Justice: close to $2 million. No taxpayers or patients benefit, only the lawyers who assaulted the hospital. Refund all the money received and document that the Government lawyers acted pro bono; then I will believe justice was served. Until then, it should be a crime that the Justice Department profits from those whom they prosecute. Show me the money. Pay back the tax payers and California patients.

Mr. Green claims it was an "unfortunate error in reporting and unintentional"? If so, he wouldn't have had to pay out $2.2 million to settle. Perhaps the FBI should investigate the entire medical community nationwide since it's obvious that Medicare fraud is wide-spread and far-reaching. Practically everyone associated with the medical community including hospitals, nursing homes, clinics and outpatient surgical facilities is guilty of the same over-billing practices. Greed is this country's new mantra and the patients are the unfortunate victims of this scheme.


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