Prime Healthcare Settlement Agreement

Prime Healthcare Services, one of the largest hospital systems in the United States, recently reached a settlement agreement with the federal government in a case involving unnecessary patient admissions and Medicare payments.

According to the terms of the settlement, Prime Healthcare will pay $61.8 million to resolve allegations that it submitted false claims to Medicare for medically unnecessary hospitalizations of patients. The government also alleged that Prime Healthcare engaged in “upcoding” – a practice in which healthcare providers bill for more expensive treatments or procedures than were actually performed.

The case dates back to 2011, when a former Prime Healthcare employee filed a whistleblower lawsuit alleging that the company was admitting patients who did not need to be hospitalized in order to increase Medicare payments. The government joined the lawsuit in 2014, and the case has been ongoing since then.

Prime Healthcare has denied any wrongdoing and maintains that its hospitals provided necessary and appropriate care to patients. In a statement, the company said that it chose to settle the case in order to “move forward and focus on delivering high-quality healthcare to our patients.”

The settlement agreement requires Prime Healthcare to enter into a corporate integrity agreement with the Department of Health and Human Services (HHS) and to implement compliance measures designed to prevent similar issues from occurring in the future. The company will also be subject to ongoing monitoring and audits to ensure compliance with the agreement.

This settlement is just one example of the government`s increased focus on healthcare fraud and abuse. In recent years, the government has stepped up enforcement efforts, particularly in the areas of Medicare and Medicaid fraud. Healthcare providers must be vigilant in ensuring that their billing practices are compliant with federal regulations in order to avoid costly fines and legal action.

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