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Duke Health to pay $1M penalty for overcharging government

Posted March 21

— Duke University Health System has agreed to pay $1 million to settle allegations that it overcharged government insurance programs, state and federal authorities said Friday.

Leslie Johnson, a former employee of a Duke Health-owned firm that handles billing and collection services for the hospital system, filed a whistleblower lawsuit in December 2012 under the False Claims Act, which attracted the attention of the U.S. Attorney's Office and the North Carolina Attorney General's Office.

"Health care fraud like this wastes tax dollars, harms patients who need care and drives up medical costs for all of us,” Attorney General Roy Cooper said in a statement. “We’re working closely with federal officials to root out this kind of fraud in North Carolina and make wrongdoers pay."

Duke Health allegedly overcharged the Medicare, Medicaid and TRICARE insurance programs by billing the government for services provided by physician
assistants during coronary artery bypass surgeries when they were acting as surgical assistants and by unbundling claims in connection with cardiac and anesthesia services to increase costs, authorities said.

Authorities didn't specify when the alleged overbilling occurred or which of Duke's three area hospitals – Duke University Hospital and Duke Regional Hospital in Durham and Duke Raleigh Hospital in Raleigh – was involved. Duke Medicine spokesman Doug Stokke said the $1 million settlement covers disputed charges over a six-year period.

Duke denies any illegal activity, blaming any overcharges on "an undetected software problem" and "possible misapplication of certain technical billing requirements," Stokke said in a statement.

"Duke had no intent to submit inaccurate claims and denies that it violated the False Claims Act," he said. "DUHS has a robust corporate compliance program and is committed to the highest standards of ethics and integrity in all of our interactions with governmental health care programs."

25 Comments

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  • scubagirl2 Mar 24, 11:16 a.m.

    they'll recoop by overcharging the patients now. We already pay out the nose for a 15 minute appointment, which is what the docs are now allotted to see a pt. in the office/clinic...

    I am also a former DUMC employee(RN)-paid my dues for over 20 years- and I am glad to see them busted for doing this.

  • ospreysilver Mar 24, 10:52 a.m.

    Hospitals get to make up the prices for services and doctors get paid even when they mess up. What other business gets to charge thousands differently between locations for the same services, aren't expected to explain or tell people the cost of services before hand, and get paid regardless of the result? Just the hospitals and politicians! If your car mechanic sent you a bill for 5K for running a engine diagnostic it would be criminal, but over charging 4K for an ER diagnostic is standard business practice at hospitals. It's like the big banks who ripped off the world, then got bailed out, and still get to rob. Its never a person in charge's fault!

  • Jump1 Mar 24, 10:46 a.m.

    Only that, they will get that back in the next round, Ob care will take care of it,

  • archmaker Mar 24, 9:34 a.m.

    $1 million settlement covers disputed charges over a six-year period.

    this doesn't clearly say how much money was actually over-charged, just how much the settlement was for.

    I hope this isn't like the game at the state fair where someone can guess your weight for a $1 and if you win, you get a 10 cent prize...

  • barbstillkickin Mar 24, 8:08 a.m.

    Wow that is like me paying 100 dollars for a fine. Hope our bill does not rise that much. You know pass the buck and all.

  • soapbox Mar 21, 6:24 p.m.

    But....But.... I thought all the fraud was committed by the Entitled Poor?

    — Posted by GOPtakersSociety

    It was. Most of this was Medicaid fraud. The most corrupt entitlement scam in the federal... View More

    — Posted by foodstamptrader

    Of course. Because Duke Medical would never DREEEEAM of overcharging a private insurance company, right?

  • heelsgirl05 Mar 21, 5:35 p.m.

    pffffftttt. a million dollars is a drop in the bucket for Duke compared to what they make in a year.

  • Hooty Hoot Mar 21, 5:11 p.m.

    Just wondering if all the billing " mistakes" resulted in over payments to Duke. You would think some would have resulted in under payments.

  • thomasew52 Mar 21, 4:39 p.m.

    And this is just one health care provider, in one city. Just imagine what goes on all over the country. Scary.

  • whatelseisnew Mar 21, 4:29 p.m.

    ""Health care fraud like this wastes tax dollars, harms patients who need care and drives up medical costs for all of us,” Attorney General Roy Cooper said in a statement. “We’re working closely with federal officials to root out this kind of fraud in North Carolina and make wrongdoers pay.""

    Sorry Roy buy the fraud is really coming from the Government. What is driving up the costs are in fact Medicare, Medicaid and Tricare because they UNDERPAY the providers and the underpayment is either passed on to people with private insurance or the system is used to extract an actual fair amount of money from the lousy Government insurance. Here is an idea, get rid of those programs so the Government stops stealing health care and forcing others to pay for it. At the very least, make it illegal for the providers to pass the costs over to people with private insurance.

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