Alleged false claim filings to cost Duke $1M

Mar. 21, 2014 @ 08:43 PM

Duke University Health System has agreed to pay $1 million to resolve allegations that it made false claims to federal health care programs.

The settlement was announced Friday by Thomas G. Walker, U.S. Attorney for the Eastern District of North Carolina, and N.C. Attorney General Roy Cooper.
Resolution of the case doesn’t determine liability, but instead leaves the claims classified as allegations.
The allegations were raised by a whistleblower lawsuit, filed by former employee Leslie Johnson. She worked for Duke’s Patient Revenue Management Organization, which provided billing, collection and administrative services to the health system.
In her suit, Johnson accused the nonprofit corporation that operates Duke University Hospital, Duke Regional Hospital and Duke Raleigh Hospital of making false claims to Medicare, Medicaid and TRICARE. She also alleged that the system billed the government for services provided by physician assistants during coronary artery bypass surgeries when the PA’s acted as surgical assistants, which isn’t allowed under government regulations. Further, she alleged that the system increased billing by unbundling claims, specifically in connection with cardiac and anesthesia services.
“Allegations of health care fraud will be zealously pursued in North Carolina,” Walker said in a statement Friday. “We encourage our citizens to report potential health care fraud to the appropriate authorities. Duke University Health System was forthcoming with the information, and was cooperative in the investigation and resolution.”
Cooper indicated in a statement that his office is working with federal officials to make sure violators pay for such missteps.
“Health care fraud like this wastes tax dollars, harms patients who need care and drives up medical costs for all of us,” he said.
In a statement released late Friday, Duke denied that it intended to submit inaccurate claims, violating the False Claims Act.
“For settlement purposes only, we have agreed to pay back the Medicare, Medicaid and TRICARE programs payments received over a six-year period for claims that resulted from an undetected software problem and through possible misapplication of certain technical billing requirements,” said Doug Stokke, vice president of marketing and communications for Duke Medicine.