The Justice Department announced today that 55 hospitals across the country have agreed to pay a total of $34 million to settle charges that they overcharged Medicare for Medtronic’s kyphoplasty spine procedure.
According to the Justice Department’s press release, kyphoplasty, a minimally invasive procedure used to treat certain spinal fractures that often are due to osteoporosis, can often be performed safely and effectively as an outpatient procedure without the need for a more costly hospital admission. The settlements announced today resolve allegations that the hospitals frequently billed Medicare for kyphoplasty procedures on an inpatient rather than an outpatient basis, in order to increase their Medicare billings.
“Hospitals that participate in the Medicare program must bill for their services accurately and honestly,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division of the Department of Justice. “The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire of medical providers to maximize profits.”
The Justice Department has now reached settlements with more than 100 hospitals totaling approximately $75 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures. In addition to today’s settlement, the government previously settled with Medtronic Spine LLC, which acquired Kyphon Inc. in 2007, for $75 million to settle allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures.
MassDevice reports that all but four of the hospitals in the latest settlement were part of a whistleblower lawsuit filed by former Kyphon employees, who are in line to receive about $5.5 million from the settlement.