Banner Health will pay more than $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis.
According to the government, from November 1, 2007 through December 31, 2016, Banner Health allegedly billed Medicare for "short-stay, inpatient procedures" performed at the 12 hospitals that should have been billed on a less costly outpatient basis. The government also alleged that Banner Health inflated in the number of hours for which patients received outpatient observation care in their reports to Medicare.
“Taxpayers should not bear the burden of inpatient services that patients do not need,” said Acting Assistant Attorney General Chad A. Readler for the Justice Department’s Civil Division. “The Department will continue its efforts to stop abuses of the nation’s health care resources and to ensure that patients receive the most appropriate care.”
Reportedly, Banner Health entered into a corporate integrity agreement with the U.S. Department of Health and Human Services Office of Inspector General that requires the system to retain an independent review organization to evaluate the accuracy of the company's claims for services to federal healthcare program beneficiaries.
The settlement doesn't involve any findings of wrongdoing on Banner's part, said Becky Armendariz, senior director of marketing and public relations for the Phoenix-based health system.
The whistleblower, Cecilia Guardiola, a former Banner employee, share of the settlement will be approximately $3.3 million.
