University of Colorado Health (UCHealth) has agreed to pay $23 million to settle allegations of violations under the False Claims Act, the U.S. Attorney’s Office for the District of Colorado announced Tuesday. The settlement stems from UCHealth’s improper billing practices related to Medicare and TRICARE, the federal health care programs.
According to the U.S. Department of Justice, UCHealth was accused of falsely coding certain Evaluation & Management (E&M) claims for emergency department visits between November 1, 2017, and March 31, 2021. The health system allegedly used automatic coding practices that resulted in improper payments from federal health programs.
The coding was applied to emergency room claims when healthcare providers recorded more sets of vital signs than the duration of a patient’s visit to the emergency department. This practice occurred regardless of the patient’s actual condition or the resources used for treatment, and the U.S. government alleges that the health system knew this coding did not meet the necessary billing requirements for 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 of the District of Colorado. “We will hold accountable health care companies that adopt automatic coding practices that lead to unnecessary and improper billing.”
Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, also addressed the severity of the issue: “Improperly billing federal health care programs drains valuable government resources needed to provide medical care to millions of Americans. We will pursue health care providers that defraud the taxpayers by knowingly submitting inflated or unsupported claims.”
The settlement also resolves claims under the qui tam provisions of the False Claims Act, which allows whistleblowers to file lawsuits on behalf of the government. In this case, the whistleblower, Timothy Sanders, will receive $3.91 million from the settlement.
UCHealth did not admit liability but agreed to the settlement to resolve the allegations.
The settlement serves as a reminder of the importance of accurate billing practices in the health care industry and the government’s continued efforts to combat fraud in federally funded health programs.
