Wilcox Memorial Hospital last week paid the federal government over $1.5 million “to resolve allegations that it over-billed federal health-care programs,” according to the Honolulu office of the U.S. Attorney. Wilcox denies the allegations and admits no wrongdoing, though it
Wilcox Memorial Hospital last week paid the federal government over $1.5 million “to resolve allegations that it over-billed federal health-care programs,” according to the Honolulu office of the U.S. Attorney.
Wilcox denies the allegations and admits no wrongdoing, though it paid back to various federal health-insurance agencies the alleged over-billed amounts, plus an undisclosed amount which is the same as a fine or penalty, said Mark Recktenwald, the U.S. attorney who handled the case for the U.S. government.
The money paid by Wilcox comes out of a reserve established when the federal investigation started two years ago, said Lani Yukimura, hospital spokeswoman.
Denial of allegations and admittance of no wrongdoing is “not an unusual provision” in a settlement agreement like this, Recktenwald said.
According to federal investigators, Wilcox allegedly billed federal Medicare and Tricare (for military dependents) programs at higher-than-average rates in pneumonia cases between 1995 and 1998.
That drew the attention of federal regulators from the U.S. Department of Health and Human Services inspector general’s division, which was conducting a nationwide investigation into suspected over-billing, Recktenwald continued.
A two-year probe ensued that also involved the Federal Bureau of Investigation and U.S. Department of Defense Criminal Investigative Service, during which time Wilcox cooperated.
“Wilcox’s willingness to address this matter forthrightly contributed to a resolution that is fair and appropriate,” said Edward H. Kubo, Jr., U.S. attorney for Hawai’i.
“Wilcox was very cooperative and forthright,” Recktenwald concurred.
Eventually, the investigation uncovered alleged over-billing in nine other types of inpatient medical services rendered, in addition to the pneumonia over-billing, Recktenwald said.
The government alleged that the claims were not adequately supported by patient medical records.
Yukimura confirmed that no patients had to pay higher-than-normal co-payments as a result of the alleged over-billing of the federal agencies.
Under Medicare and Tricare rules, patient co-payments are set, flat rates, not influenced by the total cost of a procedure. Medicare is the federal health-care program for senior citizens, and Tricare is the federal program for military dependents.
The settlement mandates Wilcox install a corporate integrity plan, implement procedures to ensure accuracy of billings to Medicare, undergo periodic audits, and maintain a hotline for the reporting of allegations of fraud and abuse.
Wilcox agreed to abide by the corporate integrity plan for three years, and either had in place or was in the process of installing procedures to monitor and ensure correct billing, Recktenwald added.
Wilcox maintains the alleged mistakes were just that, mistakes, and that steps have been taken to prevent reoccurrence. Mechanisms have been put in place to detect and promptly correct any reoccurrence, and staffing changes took place “that will prevent such mistakes from happening again,” according to a statement from the hospital yesterday.
“Today’s settlement is the result of nearly two years of investigation and cooperation between Wilcox Memorial Hospital and the government, stemming from a limited, flawed procedure of Medicare coding covering a period from 1995 through 1998,” the hospital said in the press release.
“We have worked diligently with the Department of Justice and the Office of Inspector General (of the federal DHHS), and found that the documentation issues were not intentional and did not compromise clinical care,” the hospital statement continued.
More stringent monitoring, additional training “regarding compliance with increasingly complex rules and regulations governing the delivery of health care,” and other fixes have been installed or are in the process of being implemented, the hospital concluded.
Staff Writer Paul C. Curtis can be reached at mailto:pcurtis@pulitzer.net or 245-3681 (ext. 224).
