Case Study

Yet another hospital fraud case

Community Health Network settles false claims allegations for $20.3M

Community Health Network, a nonprofit system based in Indianapolis, has agreed to pay $20.3 million to resolve allegations it submitted false claims to the Medicare and Medicaid programs, according to the Department of Justice.

The government specifically alleged CHN submitted bills to Medicare and Medicaid for outpatient surgical services that had been performed at ambulatory surgery centers that were not owned by CHN. The bills falsely showed procedures were performed in the outpatient department of one of CHN's hospitals, rather than in an ASC.

The billing rates for surgeries performed in an ASC are generally lower than the rates for outpatient surgeries performed in a hospital, which resulted in CHN receiving higher reimbursement from the government payers than it was entitled, according to the DOJ.

The alleged overbilling by CHN began in the late 1990s and continued through October 2009.

In addition to the monetary settlement, CHN also agreed to enter into a Corporate Integrity Agreement with HHS' Office of Inspector General.

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