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UCHealth agrees to pay $23 million to settle allegations of fraudulent billing during emergency visits

Online Niel November 13, 2024

DENVER, Colo. (KKTV) – University of Colorado Health has agreed to pay $23 million to settle allegations that it violated the False Claims Act by seeking and receiving payments from federal health care programs for emergency department visits, according to the Colorado US Attorney’s Office. .

The claims said UCHealth falsely coded some assessment and management claims that were submitted to the Medicare and TRICARE systems.

On Tuesday, UCHealth responded to the allegations following the settlement:

“UCHealth is pleased to see the end of this lengthy and resource-intensive investigation. UCHealth denies these allegations, but agreed to the settlement to avoid potentially lengthy and expensive litigation. The agreement allows us to focus our resources on providing excellent patient care.”

The U.S. Attorney’s Office said that through these false codings, UCHealth allegedly billed some ER visits that described the highest use of the hospital’s resources, when that was not always the case.

They said that between Nov. 1, 2017, and March 31, 2021, hospitals coded claims for emergency room visits that described the greatest use of hospital resources. Healthcare providers would have checked the patient’s vitals more times than the total number of hours the patient spent in the emergency room, without regard to the severity of the patient’s actual medical condition or the hospital resources used to help the patient.

“Fraudulent billing by health care companies undermines Medicare and other federal health care programs that are vital to many Coloradoans,” said U.S. Attorney Matt Kirsch for the District of Colorado. “We will hold accountable health care companies that adopt automated coding practices that lead to unnecessary and improper billing.”

The settlement included claims brought against private individual Timothy Sanders in Sanders v. University of Colorado Health et al. The U.S. Attorney’s Office said Sanders received $3.91 million in the proceeds of the deal.

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