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Forum reimburses US for overbilling Medicare
By WILLIAM K. ALCORN
YOUNGSTOWN
Forum Health will reimburse the U.S. government $2,862,484 for inadvertently overbilling Medicare.
In a settlement agreement negotiated with the U.S. Attorney’s office and the Department of Health and Human Services, Forum agreed that its Western Reserve Care System (Northside Medical Center in Youngstown) and Trumbull Memorial Hospital in Warren will pay $2,103,821 and $758,663 respectively.
Forum Health, recently purchased by Community Health Systems for $120 million, was a nonprofit corporation that operated NMC, TMH and Hillside Rehabilitation Hospital in Howland.
The sale of Forum Health, approved by the bankruptcy court, is in the process of being finalized.
Forum Health filed March 16, 2009, for protection under the U.S. Bankruptcy Code.
The settlement, approved by U.S. Bankruptcy Judge Kay Woods, was a “significant victory for taxpayers,” said Steven M. Dettelbach, U.S. Attorney for the Northern District of Ohio.
Dettelbach said Forum voluntarily disclosed that it had been overpaid for charges on hospital stays between Jan. 1, 2003, and Jan. 13, 2009.
The U.S. Attorney said the hospitals inappropriately billed because its billing system associated two codes, rather than permitting billing personnel discretion in determining whether using both was appropriate.
Patient discharge status Code 06 reimburses the hospital for the entire patient stay when the patient is discharged to home. It requires home-health care unless the hospital stay is classified as a qualifying diagnosis related group (DRG), in which case, the hospital is reimbursed on a calculated per diem rate.
The use of condition Code 42 indicates that the home-health care is unrelated to the reason for the hospital stay and results in a higher DRG reimbursement, which is why Forum overbilled, Stevens said.