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Wis. hospitals face $11 million fine

MILWAUKEE, Dec. 13 (UPI) -- Two hospitals owned by Aurora Health Care, the largest private employer in Wisconsin, Friday faced possible fines of $11 million plus restitution for allegedly overbilling Medicare and Medicaid.

A federal complaint alleges St. Luke's Medical Center and Aurora Sinai Medical Center submitted fraudulent billings for experimental heart treatments on some 1,000 patients between 1986 and 1995.

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Aurora officials blamed the billings on a paperwork error. Aurora President G. Edwin Howe said the hospitals didn't knowingly do anything wrong.

The billings involve pacemakers, catheters, angioplasty balloons and other cardiac devices that had been approved for clinical trials but not yet deemed "safe and effective" by the Food and Drug Administration.

Medicaid and Medicare rules at the time prohibited such payments although the rules have since been revised.

"They billed as if they were covered and didn't disclose if it was experimental," Assistant U.S. Attorney Christian L. Larsen said.

Howe said the devices in question were improved versions of equipment already in use.

"The argument is we should have withheld the best care until the final approval was available," he told the Milwaukee Journal Sentinel. "We feel we should give our patients the best stuff out there. This is the right thing to do for patients."

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The complaint said the government mistakenly paid the hospitals millions and seeks to recover as much as $10,000 for each of the 1,100 allegedly faulty claims.

The Wisconsin hospitals are among 132 nationwide that face similar complaints. Settlements already have been reached with 31 hospitals, ranging from $107,500 to $10.75 million. Forty-five other hospitals are still in negotiations and cases against the rest have been dismissed.

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