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U of C Hospitals
faces civil suit
The U of C recently made Chicago Tribune headlines with news that
the U.S. attorney’s office in Chicago filed a civil lawsuit
against the University, the University of Chicago Physicians Group,
and the University of Chicago Hospitals, alleging that the defendants
overbilled Medicare and Medicaid.
Initiated in 1996, the suit claims that many of the outpatient
Medicare claims for physician services submitted from 1991 to 1997
should actually have been billed at a lower rate. The University
denies the allegations, stating in its response that the federal
government is applying new requirements that were not in effect
when the services were billed.
The Hospitals’ billing practices first came under scrutiny
as part of a Department of Health and Human Services (HHS) initiative
called Physicians at Teaching Hospitals (PATH). Since 1995, HHS
has launched PATH audits at more than 50 of the nation’s 125
major academic medical centers. The U.S. attorney’s office
has brought charges against a number of universities, with several
settling multimillion-dollar complaints out of court. In the first
and largest such agreement, the University of Pennsylvania settled
for $30 million. More recently, several other medical centers have
settled for much smaller sums; two more settled for nothing.
PATH audits have focused on inpatient billing practices, and the
U of C has not been charged with submitting false claims connected
to its inpatient billings.
The investigation into the Hospitals’ outpatient billings
began after a private citizen filed a qui tam suit claiming those
billings were false and fraudulent.
“We believe that suit is totally without merit,” wrote
Hospitals CEO Ralph Muller and Biological Sciences Division Dean
Glenn Steele in a letter to the Chicago Tribune.
After studying the PATH audits, the General Accounting Office,
a government research agency, noted in a 1998 report that Medicare
regulations were not always clear and had sometimes been misinterpreted—and
that the medical community believes the government “is coercing
settlements from teaching institutions through threats of federal
lawsuits.”—K.S.
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