"This was a case of inappropriate behavior," hospital President Victor Broccolino said yesterday. "The employee took it upon [himself or herself] to alter bills or submit bills without them being recertified [by a physician]."
The settlement, announced at an news conference at the Columbia hospital yesterday afternoon, follows an investigation by the federal Health and Human Services Office of the Inspector General and the FBI.
From February 1989 through July 1992, the hospital submitted 236 fraudulent reimbursement claims for physical therapy services, according to the settlement agreement.
Of those, 157 claims had altered physician certifications and orders. The 79 other claims did not have physician orders or certifications, the agreement stated.
Under Medicare regulations, a doctor must authorize physical therapy services through a prescription order or physician's certification.
To receive reimbursement for treatment beyond the time of the original prescription order or certification, a doctor must re-examine a patient and determine whether treatment should continue.
Mr. Broccolino said the clerical employee, who was not named and has since been fired, altered dates and the level of treatment on documents needed to receive reimbursement for 44 Medicare patients undergoing physical therapy at the hospital. "The employee was trying to ensure that the hospital received reimbursement for services rendered," said Mr. Broccolino, who characterized the worker as "well-intentioned."
Mr. Broccolino said the hospital agreed to the settlement to avoid a costly legal fight with the U.S. government. "We saw no value in perpetuating the issue and protracting it as a civil case," he said.
In addition to the fine, the county General Hospital has agreed to a random, annual review of its Medicare billing procedures during the next two years.