Hospital owner faces hefty fine for billing error
OKLAHOMA CITY – Improper billing leads to a hefty fine for the owner of St. Anthony Hospital.
SSM Healthcare of Oklahoma has agreed to pay $475,000 to the United States to settle civil claims.
Prosecutors allege from 2007 to 2009, SSM billed Medicare for in-patient services that should have been billed as outpatient services.
That change in paperwork lead to higher reimbursements to the hospital owner.
As part of the settlement, SSM did not admit any wrongdoing and the government did not make any concession regarding the legitimacy of the claims.
Experts say the agreement helps everyone avoid the expense and inconvenience of a trial.
SSM released the following statement:
“SSM Health Care of Oklahoma entered into an agreement based on the results of a Zone Program Integrity Contracts Audit conducted in 2009 on a sample of claims from 2007-2008. ZPIC conducts similar audits in hospitals nationwide to review the medical necessity for admission and designation as an inpatient vs. an outpatient, also known as “observation” patient. In both cases, the patient spends the night at the hospital.
The audit revealed some patients would have been more appropriately designated and billed as an observation patient rather than as an inpatient. SSMOK has fully cooperated with the Department of Justice and has implemented numerous changes based on the audit findings to ensure appropriate designation of these patients in the future.
During the audit process that has lasted approximately four years, SSMOK engaged a third party consultant to conduct an independent audit. The independent audit report revealed the error rate to be significantly lower than that used as a basis to calculate the settlement by the United States Department of Justice. However, in the interest of avoiding further litigation and incurring additional legal expenses, SSMOK decided it was in the best interest of both parties to settle.”