Whistleblower case on Providence's billing tactics won't be revived, court rules

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A whistleblower case against Providence that accuses the Renton, Wash.-based health system of upcoding Medicare claims won't get a new life, the 9th U.S. Circuit Court of Appeals said May 12, according to Reuters.

The court denied a petition from data analytics firm Integra Med Analytics, allowing a panel's ruling in March that dismissed the lawsuit to stand.

In a 2018 lawsuit filed against Providence and its clinical documentation contractor J.A. Thomas and Associates — now part of Nuance Communications — Integra accused the defendants of routinely using unwarranted major complication and comorbidity secondary codes on Medicare claims to inflate reimbursement. Integra's allegations relied heavily on an analysis of billing data.

In the panel's March 31 order, three judges ruled statistical discrepancy wasn't enough to support Integra's False Claims Act accusations, according to Reuters.

"It is reasonable that Providence, one of the largest healthcare systems in the country, which specifically hired consultants to improve its Medicare billing, would be at the forefront of a national trend toward coding these relevant [major complications or comorbidities] at a higher rate," the panel wrote.

Attorneys for Integra and Providence didn't immediately respond to Reuters' request for comment. 

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