Pennsylvania hospital, RCM vendor settle billing fraud allegations

Phoenixville (Pa.) Hospital and Firstsource Solutions, a revenue cycle services provider, have agreed to pay a combined $325,000 to settle False Claims Act allegations, according to the Department of Justice

The settlement resolves allegations that Phoenixville Hospital violated the False Claims Act by submitting altered forms to the Pennsylvania Department of Human Services, which administers the state's Medicaid program. The forms were allegedly altered to remove the option for the medical provider to certify that self-pay patients were "employable" and therefore not disabled and not entitled to Medicaid coverage for the services the hospital billed for, according to the Justice Department. 

The hospital allegedly submitted the altered forms from January 2008 through February 2012, before it joined West Reading, Pa.-based Tower Health in October 2017. The hospital agreed to pay $100,000 to resolve the false claims allegations. 

Firstsource Solutions, which provided revenue cycle services to Phoenixville Hospital, allegedly submitted false claims for inpatient treatment and/or emergency room visits billed by the hospital. Firstsource allegedly submitted the false claims from August 2009 through February 2012. The company agreed to pay $225,000 to resolve the allegations. 

The allegations were originally brought in two cases filed under the qui tam, or whistle-blower, provisions of the False Claims Act.

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