UCSD MED CENTER: Settles False-Billing Suit for $4.7 Million

      In one of a growing number of prosecutions involving whistle- blower suits under the False Claims Act, University of California-San Diego Medical Center officials "have agreed to pay $4.7 million to settle federal claims that the hospital knowingly miscoded bills for heart surgeries because the experimental procedures weren't covered by Medicare or the military's health plan," the San Diego Union-Tribune reports. "UCSD, together with the physicians who actually performed the procedures, used a reimbursement code that made these procedures appear to be covered services when in fact they were not," said Assistant U.S. Attorney Stephen Segreto. He added, "Although UCSD is a large institution, and we understand mistakes can be made in billing, it's our allegation that these were not mere mistakes." But UCSD attorney David Robbins countered that the medical center "did not do anything wrong," saying, "There was substantial ambiguity in the federal law" with regard to appropriate reimbursement of experimental, but medically necessary, procedures or devices. The Union-Tribune reports that nearly 75% of the cases in question "involved the use of a device called a Rotablator, a catheter whose fast-spinning head disperses heart-clogging plaque." Other devices involved in the case "include pacemakers, defibrillators, stents, coronary and peripheral lasers, valves, catheters and catheter guide wires, all of which were experimental." UCSD officials said yesterday that "like the scores of other hospitals involved in this dispute, UCSD maintains that the rules in place at the time were ambiguous and not applicable to charges for medically necessary services." Sharp Memorial Hospital settled a similar suit last month, agreeing to pay $863,712 (Clark, 9/16). The Los Angeles Times reports that the settlement "is expected to increase pressure on 127 other research centers, which face similar federal charges, to settle with prosecutors" (Silverstein, 9/16).