Rex Healthcare to Pay $1.9M to Settle Fraud Claims

John Commins, for HealthLeaders Media , April 5, 2011

Federal prosecutors have used the False Claims Act to recover $5.3 billion since January 2009 in cases involving fraud against federal healthcare programs. DOJ's total recoveries in False Claims Act cases since January 2009 have topped $6.8 billion. 

Linda Butler, MD, CMO of Rex Healthcare said in a phone interview with HealthLeaders Media:

"We don't feel like we did anything wrong. We were following rules at the time but it was probably easier and cheaper to settle than to fight the government on this. We were performing this procedure on elderly frail patients in their 70s and 80s who were in excruciating back pain and they had a lot of problems like cancer and cardiac issues. Some even spent the night in the ICU due to their frail state. During that time we were following the InterQual third-party billing recommendations to bill this as an inpatient procedure. In 2007 when it was deemed to be an outpatient procedure we began billing it as outpatient. When the government decided to retroactively penalize people who had billed it as inpatient before 2007 we were caught with that. We didn't think we did anything wrong. We think it is unfair, but it was probably better to settle."

John Commins is a senior editor with HealthLeaders Media.

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