Unnecessary spinal procedures remain in the national spotlight

Thirty-two more hospitals settle FCA allegations, adding to more than 100 providers that have settled for similar billing infractions

The Department of Justice has secured $28 million in False Claims Act (FCA) settlements from 32 hospitals for improperly billing a minimially invasive spinal procedure, adding to a long history of previous settlements with more than 100 hospitals and a manufacturer.

The recent settlment resolves claims that the hospitals in question billed for kyphoplasty as an inpatient claim, according to the DOJ. Kyphoplasty is a minimally invasive spinal procedure that treats fractures brought on by osteoporosis, which is supposed to be billed as a less costly outpatient procedure.

Including this week's announcement, the DOJ has reached settlements with more than 130 hospitals for $105 million for improperly billing kyphoplasty procedures stretching back eight years. In 2012, 14 hospitals agreed to pay $12 million to resolve FCA allegations tied to kyphoplasty procedures, and the following year, another 56 hospitals agreed to pay more than $34 million. In 2008, Medtronic Spine LLC paid $75 million to settle claims that the company instructed hospitals to submit kyphoplasty procedures as inpatient claims.

Hospitals involved in the recent settlement include the Cleveland Clinic, Tampa General Hospital, and providers within Community Health Systems, Tenet Health Care Corporation and Banner Health. Seven Florida hospitals accounted for $9 million of the settlement. 

To learn more:
- read the DOJ announcement

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