Hospital tagged in first transfer initiative settlement
May 22, 2000 2 minutes read
Hospital tagged in first transfer initiative settlement
In what may be the first in a long line of settlements under the prospective payment system (PPS) transfer project, Beebe Medical Center in Lewes, DE, has agreed to pay the government $1.3 million, according to the Department of Health and Human Services’ Office of Inspector General (OIG). The settlement was announced May 9.
Earlier this year, the OIG’s top counsel, Mac Thornton, revealed that roughly 200 hospitals are under investigation as part of this national initiative, which is examining patient transfers. Under the PPS, if a patient is discharged home from the hospital, the hospital is entitled to the full diagnosis related group (DRG). But if the patient is transferred to another hospital, the transferring hospital should receive only a prorated share of the DRG.
The government charged Beebe under the False Claims Act with knowingly submitting false claims for patients that were discharged to their homes or to other facilities when in fact the patients were really transferred to another hospital.
OIG spokeswoman Alwyn Cassil says the OIG has done significant audit work dating back to the mid-1980s identifying this as a problem. "This is very analogous to the DRG three-day window initiative where we did audit after audit after audit trying to put the provider community on notice that this was an improper way of billing."
That stream of audits is what turned this into a national initiative with both the Department of Justice and the OIG pursuing cases under the False Claims Act, she added. "At some point, when the behavior doesn’t change, it moves from an error to deliberate ignorance of what the requirements are."
James Monihan, Beebe's vice president of administration and chief compliance officer, acknowledges that the hospital made some errors. But he adds that the hospital was particularly vulnerable because it had no way of knowing when patients that were at the hospital while on vacation were later readmitted to another hospital. "My point to the OIG was that if it can get this information by punching a button, it should feed this information to us periodically," he says. "HCFA's fiscal intermediaries never detected any problem whatsoever."
Monihan also takes exception with OIG's characterization that Beebe "knowingly" made those mistakes. "Throughout the negotiations, we made the point — and were never challenged — that this was not done intentionally," he asserts. "It was not done intentionally, and you can't even find any pattern to it."
Beebe already had a compliance program in place, according to Monihan. He says the OIG simply quantified that as one hour of education for all employees, as well as three additional hours for patients involved in patient care, coding, or billing.
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