Banner Health to pay $18M for Medicare-related claims in Arizona
Apr 12, 2018, 6:33 PM
The exterior of Banner Health Cardon Children's Medical Center. (Facebook/Banner Health)
(Facebook/Banner Health)
PHOENIX — A Phoenix-based health care company will make a more than $18 million payment to settle allegations of false Medicare claims involving hospitals in Arizona.
The United States Attorney’s Office for the District of Arizona announced Thursday that Banner Health will pay the United States to resolve allegations that 12 of its hospitals in Arizona and Colorado “knowingly overcharged Medicare patients unnecessarily” between 2007 and 2016.
The United States alleged that the company billed Medicare for short-stay, inpatient procedures that “should have been billed on a less costly outpatient basis,” according to a press release.
The settlement will also resolve allegations that Banner Health inflated the number of hours that patients received outpatient observation care in reports to Medicare during that time period.
It did not clarify which Arizona hospitals were involved.
In a statement, Chad A. Readler, the acting assistant attorney general for the Justice Department’s civil division, pointed to the settlement as another example of the government’s commitment to protecting Medicare.
“Taxpayers should not bear the burden of inpatient services that patients do not need,” Readler said.
“The department will continue its efforts to stop abuses of the nation’s health care resources and to ensure that patients receive the most appropriate care.”
The allegations first came to light after Cecilia Guardiola, a former employee of Banner Health, filed a lawsuit in the United States District Court for the District of Arizona.
“Her entire career has been dedicated to trying to make the health care industry act with integrity,” her attorney, Mitchell Kreindler, told The Associated Press.
“You can make a lot of money in health care by obeying the law and doing it with a sense of ethics and integrity.”
Banner Health has also entered into a corporate integrity agreement with the U.S. Office of Inspector General. The agreement requires the company to “engage in significant compliance efforts” for the next five years. It did not specify what those efforts were.
Banner Health officials said in a statement the settlement does not equate an admission of wrongdoing. But they are pleased to resolve the suit.
“Although the rules that dictate when a hospital can accommodate a physician’s request to admit a Medicare patient are complex and evolving, our policy has always been to make those decisions in accordance with government guidelines,” Banner Health said.
Banner Health owns and operates 28 acute-care hospitals across the country.
The federal government was also investigating a 2016 cyberattack on the provider that exposed personal information of nearly 3.7 million patients, employees, health insurance customers and others.
The company has said it expects the probe will find that Banner Health’s past cybersecurity assessments were inadequate.
The Associated Press contributed to this report.
