Rhode Island Hospital will pay $5.3 million for ordering unnecessary hospital stays that were billed to federal health care programs, the U.S. attorney for Rhode Island said Monday.
The U.S. attorney said in a statement that the hospital will reimburse Medicare and Medicaid about $2.6 million and will pay the federal government about $2.7 million in damages.
The U.S. attorney said the hospital billed for overnight stays for 260 patients who underwent gamma knife treatments between 2004 and 2009, saying the admissions were medically necessary when they were not.
"All the gamma knife procedures were medically necessary; however, the (Department of Justice) contends that the hospital classified gamma knife as an inpatient procedure when it should have been classified as an outpatient procedure. The hospital has complied fully with the DOJ investigation, but admits no wrongdoing, and by settling avoids incurring the additional and significant costs associated with litigation," a statement from the hospital said.
The hospital said Medicaid and other private payors routinely preauthorized gamma knife as an inpatient procedure for more than 10 years. Rhode Island Hospital said it applied the same level of care to Medicare patients, believing it represented the standard practice of care.
Gamma knife treatment is usually used to slow the growth of small, deep brain tumors that are difficult to remove surgically.
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