UCHealth agrees to pay $23 million settlement to resolve allegations of fraudulent billing
DENVER, Colo. (KRDO) – University of Colorado Health (UCHealth) is agreeing to pay millions in settlement costs to resolve allegations that it filed false claims to federal health care programs.
According to a release from the U.S. Attorney's Office for the District of Colorado, UCHealth agreed to pay $23 million to settle claims it violated the False Claims Act by "falsely coding certain Evaluation & Management (E&M) claims submitted to the Medicare and TRICARE programs."
E&M claims relate to medical visits that involve evaluating and managing a patient’s health and medical conditions, including qualifying visits to a hospital’s emergency department.
According to the release, a hospital may use one of five different codes when submitting an E&M claim to Medicare or TRICARE, depending on the resources used during the patient's visit.
The government claims that from Nov. 1, 2017, through March 31, 2021, UCHealth hospitals automatically coded certain emergency room visit claims with the code corresponding to the highest resource usage, even when treatment didn't meet the requirements for billing Medicare and TRICARE.
“Improperly billing federal health care programs drains valuable government resources needed to provide medical care to millions of Americans,” said Principal Deputy Assistant Attorney General Brian M. Boynton in the release. “We will pursue health care providers that defraud the taxpayers by knowingly submitting inflated or unsupported claims.”
The allegations first came to light after a former UCHealth billing code specialist filed a qui tam lawsuit against the hospital system on behalf of the government. According to the release, that whistleblower will receive $3.91 million from the settlement.
UCHealth shared this statement on the settlement with our Denver news partners:
"UCHealth is pleased to see the end of this lengthy and resource-intensive investigation. UCHealth denies these allegations, but we agreed to the settlement to avoid potentially lengthy and costly litigation. The settlement allows us to focus our resources on providing excellent patient care."
