A Florida healthcare system says it has agreed to pay $26 million to settle a lawsuit alleging it admitted patients who didn't need hospitalization.
Shands HealthCare, a private, non-profit healthcare system affiliated with the University of Florida and its Health Science Center campuses in Gainesville and Jacksonville, allegedly billed Medicare and Medicaid for short overnight inpatient admissions rather than for less expensive outpatient or observation services, the Orlando (Fla.) Sentinel reported.
Terry Myers, hired by Shands as an independent consultant in 2006 and 2007 to audit the healthcare system's billing practices, told the Sentinel he uncovered "a severe lack of management oversight and a systemic failure to follow Medicare and Medicaid regulations."
"Hospitals are high risk locations for infections and medical mistakes," said Patrick Burns of Taxpayers Against Fraud, a non-profit Washington agency. "If you admit patients who do not need to be admitted, you increase their chances of getting sick."
The settlement covers only part of the allegations in the case, said Marlan Wilbanks, attorney for Myers. Still outstanding are allegations that the six hospitals submitted fraudulent claims for outpatient services.
The six hospitals involved in the case were: Shands at Starke Hospital, Shands Alachua General Hospital, Shands Jacksonville Medical Center, Shands at the University of Florida, Shands at Lakeshore and Shands at Live Oak.