Hospital owner fined for improper billing

Oct 31, 2013 | Hospital Finance Efficiency

A hospital owner in Oklahoma City is facing a major fine after his organization incorrectly billed patients from 2007 to 2009. 

The owner of St. Anthony Hospital is being fined because SSM Healthcare billed Medicare for in-patient services when they should have been billed as outpatient services. This led to higher reimbursements to the hospital owner. SSM did not admit to any wrongdoing, but agreed that paying these fines will ultimately be a better solution than going to trial. 

As a result, SSM Healthcare has agreed to pay $475,000 to settle these civil claims. The organization released a statement on the matter.

"SSM Health Care of Oklahoma entered into an agreement based on the results of a Zone Program Integrity Contracts Audit conducted in 2009 on a sample of claims from 2007-2008," the claim said. "ZPIC conducts similar audits in hospitals nationwide to review the medical necessity for admission and designation as an inpatient vs. an outpatient, also known as 'observation' patient. In both cases, the patient spends the night at the hospital."

The organization later admitted in the statement that some patients would be more appropriately designated and billed as an observation patient rather than as an inpatient. If SSM is telling the truth in regards to not intentionally doing anything wrong, it may simply be the victim of not keeping its billing department organized. This can be mitigated by working with a medical billing services provider that can help keep your financial offices organized and efficient.