Here are five things to know:
1. The Justice Department claimed that from Nov. 1, 2017, through March 31, 2021, the health system improperly billed Medicare and TRICARE for emergency department visits at its hospitals by automatically applying a high bill code when vital signs were more frequently checked than the hours a patient spent in the ED, regardless of care needs.
2. The Justice Department also alleged that UCHealth knew its high billing code for vital signs in the ED did not meet TRICARE and Medicare billing standards.
3. “Improperly billing federal health care programs drains valuable government resources needed to provide medical care to millions of Americans,” Brian Boyton, principal deputy assistant attorney general and head of the Justice Department Civil Division, said in a Nov. 12 news release. “We will pursue health care providers that defraud the taxpayers by knowingly submitting inflated or unsupported claims.”
4. The settlement is part of a whistleblower case filed by Timothy Sanders, a private individual. Mr. Sanders will receive $3.91 million from the settlement.
5. A spokesperson for UCHealth said in a Nov. 13 statement shared with Becker’s that the system is pleased to see “the end of this lengthy and resource-intensive investigation.” UCHealth denies the allegations, but agreed to settle to avoid the potential of a costly and lengthy litigation, allowing the system to focus its resources on providing patient care.
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