CASPER, Wyo. — Wyoming Medical Center will pay the federal government $2.7 million to settle a lawsuit alleging that the Casper hospital submitted fraudulent claims to Medicare.
Gale Bryden, the former WMC employee who filed the suit, will receive an unspecified share of the settlement, the U.S. Attorney’s Office for Wyoming said Monday while announcing the deal.
“This settlement emphasizes that corporations allegedly seeking to increase profits at the expense of taxpayers can expect aggressive investigation,” Gerald Roy, special agent in charge for the Department of Health and Human Service’s Office of Inspector General, said in a statement.
Bryden accused the hospital of defrauding Medicare by changing the admission status of patients to bill the government for more money and by submitting reimbursement claims that were inconsistent with patient records.
Hospital officials denied wrongdoing and maintained any billing errors that occurred were inadvertent mistakes. WMC has already taken steps to prevent errors from happening again, they said.
Bryden also claimed WMC officials fired her in retaliation for bringing the fraud issue to the government’s attention. The settlement between the government and the hospital did not address those issues.
The hospital reached a separate agreement with Bryde, WMC President Vickie Diamond said. She said the details were confidential.
“I will tell you there was no retaliation,” Diamond said.
Bryden’s attorney, Jeffrey Gosman, did not respond Monday to a phone call and email message seeking comment.
Bryden filed her whistleblower lawsuit in 2007, but it remained under seal until last year while federal authorities investigated the matter. The worker said she observed hospital staff members submitting claims to government insurers that differed from the services that were actually provided.
Federal authorities said they found evidence to support some of Bryden’s allegations. The settlement, according to the federal government, specifically resolves claims the hospital:
— Submitted higher-paying inpatient Medicare claims for outpatient procedures.
— Submitted inpatient reimbursement claims for hospital stays without any record of a doctor ordering that level of care.
— Submitted inpatient reimbursement claims for medical services provided to patients who didn’t meet inpatient admission requirements.
— Prolonged inpatient hospital admissions to qualify patients for Medicare-covered long-term care at a skilled nursing facility, leading the government to pay for services that it wasn’t obligated to pay.
“In this era of increasing health care costs and budget constraints, allegations of Medicare fraud and overbilling must be aggressively pursued in order to protect the integrity of the Medicare system,” U.S. Attorney for Wyoming Kip Crofts said in a statement.
The bills at issue represented a small percentage of the total Medicare claims Wyoming Medical Center submitted from 2002 to 2009, according to hospital officials. Workers did not intentionally submit bad claims, they said.
“We thought we were doing the correct things based on the Medicare rules,” Diamond said. “They are very complicated rules.”
The hospital cooperated with authorities during the investigation. As part of the settlement, WMC entered into a corporate integrity agreement with federal officials. Administrators will hire an independent review organization that will ensure the hospital is complying with federal guidelines, Diamond said.
WMC has taken other steps to prevent the errors from reoccurring, she said. It now uses a standardized form for physicians to use when admitting patients. Case managers review a patient’s status within 24 hours. WMC also hired more staff members and a chief compliance officer.
“We are upset we had billing errors,” Diamond said. “We’ve done everything possible to prevent that going forward.”