The owner of Lower Bucks Hospital in Bristol Township has paid $1.25 million to settle lawsuits regarding allegations of submitting false claims to Medicare. These include making patients stay in overnight beds when not necessary and billing Medicare for more expensive diagnoses than patients really had.
Known as “upcoding,” the process of fraudulently charging for more costly diagnoses is certainly illegal. U.S. Attorney McSwain alleges the practice began first when Prime acquired Lower Bucks Hospital in Oct. 2012 and lasted at least until Dec. 31, 2014.
“We are committed to ensuring that hospitals, companies that own and operate them, and their executives appropriately bill Medicare,” said U.S. Attorney McSwain. “Charging the government for more costly services than what the patient actually needs and billing the government for more serious diagnoses than what the patient actually has is a waste of taxpayer dollars. Those who engage in these practices will be held accountable.”
With a headquarters in California, Prime Healthcare Services is one of the largest hospital systems in the nation. It has 45 hospitals in 14 states. Current CEO Dr. Prem Reddy founded Prime in 2001.
This settlement is on top of a case in August 2018 when Prime paid out $65 million to the United States for allegations of upcoding in California.