HCA Will Pay $95 Million In Medicare Fraud Case

The Justice Department is expected to announce on Dec. 14 that Nashville, Tenn.-based HCA-The Healthcare Co. has pleaded guilty to "health care fraud" and agreed to pay $95.3 million to settle criminal charges that it defrauded Medicare and other federal insurance programs, the Nashville Tennessean reports. The settlement marks the end of the government's five-year case against HCA, the nation's largest hospital chain, for a "'systemic' conspiracy to defraud the government." According to the charges outlined in a one-page summary of the settlement obtained by Bloomberg News, HCA, formerly known as Columbia/HCA Healthcare, engaged in Medicare fraud by "making false statements, paying kickbacks to doctors and submitting false bills" (Russell, Nashville Tennessean, 12/14). The Justice probe of HCA, which was disclosed in 1997 when the FBI raided several HCA hospitals, "left the entire health care industry shaken," the Wall Street Journal reports (Wall Street Journal, 12/14). In May, HCA agreed to a $745 million civil settlement over charges it "overbilled for laboratory and home health care services and exaggerated the severity of pneumonia cases to maximize payments from the government" (Nashville Tennesean, 12/14). One condition of the settlement was that the Justice Department would close its criminal investigation by Dec. 31 (Wall Street Journal, 12/14).