UCHealth Settles Fraudulent Billing Case for $23 Million

UCHealth Settles Fraudulent Billing Case for $23 Million

Introduction

UCHealth has agreed to pay $23 million to settle allegations of fraudulent billing practices for emergency department visits, according to the Colorado U.S. Attorney’s Office.

UCHealth violated the False Claims Act

The hospital system, one of Colorado’s largest healthcare providers, denied the allegations but opted to settle to avoid prolonged and costly litigation. The U.S. Attorney’s Office alleges that UCHealth violated the False Claims Act by improperly coding medical claims submitted to federal healthcare programs, including Medicare and TRICARE.

Allegations on UCHealth

According to the allegations, UCHealth automatically coded certain emergency department visits at the highest severity level based on the duration of a patient’s stay and the number of vital sign checks, regardless of whether the coding met federal billing requirements. Federal authorities stated that UCHealth was aware the coding practices did not comply with federal guidelines.

What did the attorney said?

“Fraudulent billing undermines Medicare and other federal healthcare programs vital to many Coloradans,” said the Acting U.S. Attorney for the District of Colorado. “We will hold healthcare companies accountable for automatic coding practices that result in improper billing.”

$3.91 million settlement

The case was initially brought to light through a whistleblower lawsuit under the False Claims Act, which allows private citizens to sue on behalf of the government and receive a share of any recovered funds. The whistleblower in this case will receive $3.91 million as part of the settlement.

As part of the resolution, UCHealth has also agreed to review and revise its billing practices to ensure compliance with federal regulations moving forward.

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