Atlanta-based Piedmont Healthcare will pay $16 million to settle allegations that it violated the False Claims Act by billing at a more expensive inpatient rate for patients who could have received outpatient care, the U.S. Justice Department said June 25.
The settlement also resolves claims that the hospital violated the Anti-Kickback Statute when it paid an amount above fair market value to acquire Atlanta Cardiology Group in 2007.
Prosecutors allege that between 2009 and 2013, Piedmont's case managers overruled its treating physicians, overbilling Medicare and Medicaid at the more expensive inpatient care level, although treating physicians recommended performing them at a less expensive outpatient level of care.
"Billing the government for unnecessary inpatient services wastes precious government resources and taxpayer dollars," said U.S. Attorney Byung J. Pak. "All appropriate action will be taken to ensure that beneficiaries of federal healthcare programs received services untainted by overcharges and improper financial incentives."