Colorado hospital agrees to pay more than $20 million fine

AURORA, Colo. — A Colorado hospital system has agreed to pay millions of dollars in fines after allegations were made it filed false claims to government medical plans.

According to a release from the U.S. Attorney’s Office for Colorado, UCHealth agreed to pay $23 million to settle claims that it violated the False Claims Act by “falsely coding certain Evaluation & Management (E&M) claims submitted to the Medicare and TRICARE programs.”

According to a release, there are five codes hospitals could use for filing purposes that are related to the hospital’s resources corresponding with the patient’s visit. The code UCHealth was accused of using amounted to the highest resource usage, the release from the U.S. Attorney’s Office says.

The government claimed that from Nov. 1, 2017, through March 31, 2021, the hospital automatically coded certain emergency room visits with that highest code even though the patient’s treatment did not meet the requirements for billing Medicare and TRICARE. 

“Fraudulent billing by health care companies undermines Medicare and other federal health care programs that are vital to many Coloradans,” said acting U.S. Attorney Matt Kirsch for the District of Colorado. “We will hold accountable health care companies who adopt automatic coding practices that lead to unnecessary and improper billing.”

A UCHealth spokesperson shared this statement with 9NEWS:

“UCHealth is pleased to see the end of this lengthy and resource-intensive investigation. UCHealth denies these allegations, but we agreed to the settlement to avoid potentially lengthy and costly litigation. The settlement allows us to focus our resources on providing excellent patient care.”

The allegations came to light after a former billing code specialist with UCHealth filed a qui tam lawsuit against the hospital system on behalf of the government. The whistleblower will receive nearly $4 million from the settlement, according to the government’s release.