Fifty-five hospitals located throughout twenty-one states have agreed to pay the United States a total of more than $34 million to settle allegations that the health care facilities submitted false claims to Medicare for kyphoplasty procedures. Kyphoplasty is a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis.
In many cases, kyphoplasty can be performed safely and effectively as an outpatient procedure without any need for a more costly hospital admission. The settlements resolve allegations that the settling hospitals frequently billed Medicare for kyphoplasty procedures on a more costly inpatient basis, rather than an outpatient basis, in order to increase their Medicare billings.
The Justice Department has now reached settlements with more than 100 hospitals totaling approximately $75 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures. The government previously settled with Medtronic Spine LLC, the corporate successor to Kyphon Inc., for $75 million to settle allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures.
The whistleblower lawsuit was filed by two former managers for Kyphon. Pursuant to the False Claims Act, these whistleblowers will receive approximately $5.5 million from the settlement proceeds.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/July/13-civ-745.html