Newspaper article THE JOURNAL RECORD

Hospitals Pay More Attention to Billing Rules after Probe into Columbia/HCA

Newspaper article THE JOURNAL RECORD

Hospitals Pay More Attention to Billing Rules after Probe into Columbia/HCA

Article excerpt

NEW YORK -- Hospitals nationwide are re-evaluating how well they follow obscure Medicare billing rules in the wake of a government fraud probe into Columbia/HCA Healthcare, which resulted in convictions against two midlevel hospital administrators earlier this month.

Most hospitals have spent thousands of dollars to hire executives called "compliance officers" who check if the institutions are correctly billing Medicare and other government health insurance programs.

Some industry experts say hospitals have also become more conservative in billing -- in effect they are asking the government for less money for some patients. They note the change could be one reason why Medicare spending has fallen dramatically in the first half of 1998.

How much hospitals are paid by Medicare depends on many factors, including the patient's diagnosis at time of admission. A more complex case of pneumonia, for example, nets higher fees than a simple pneumonia. Hospitals that may have put more patients into the complicated category now may be more likely to bill the government for a simple case so as not to raise ire of government auditors.

The investigation into Columbia/HCA was one of hundreds occurring throughout the hospital industry in recent years. Indeed, the government has accused hundreds of hospitals of filing false claims, a civil violation which can result in huge fines. But health experts say the Columbia/HCA investigation has drawn the most attention because the chain is the nation's largest, and the inquiry included a criminal probe.

"All hospitals are trying harder to make sure they are in compliance with billing rules," said Tom Smith, president of VHA, a consortium of 1,800 nonprofit hospitals and affiliated health organizations.

"The problem is there are 120,000 pages of Medicare regulations and the opportunity for failure to comply is enormous. …

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