Health Information Management

News: Hospital settles allegations of False Claims Act violations related to malnutrition and leading queries

CDI Strategies, April 12, 2012

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A Maryland hospital allegedly added malnutrition as a secondary diagnosis, employing tactics that included the submission of leading queries to increase reimbursement, according to a March 28 release from the U.S. Department of Justice in Maryland. Although the facility, Good Samaritan Hospital (GSH), denied the accusations, it agreed to pay nearly $800,000 to resolve the False Claims Act violation allegations.

From January 1, 2005 through December 31, 2008, Good Samaritan Hospital (GSH) submitted fraudulent claims to the government making “false statements that certain conditions existed that were not actually diagnosed or treated during patients’ admissions, including claims that patients suffered from malnutrition,” the release states.    
“The clinical forms that GSH used also injected false diagnoses of malnutrition into the record, which the coders then used to justify the code. By falsely coding inpatients with a secondary diagnosis of malnutrition, GSH caused its patient profile to appear worse than it was, thus increasing its reimbursement rate,” the release states.
The False Claims Act is the government’s primary civil tool to combat fraud and abuse in federal programs and procurement.  It allows the government to recover triple the amount of its actual damages, plus a civil penalty of $5,500 to $11,000 for each false claim, and permits the payment of a portion of any settlement or judgment under the Act to individuals who bring fraud to the attention of authorities.   
Editor’s Note: For additional information regarding documentation and compliant queries for malnutrition read:

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