Kyphoplasty billing fraud whistleblowers get $5M: 5 key notes

Spine

The whistleblowers in the case against 32 hospitals that fraudulently billed Medicare for inpatient kyphoplasty when the will split $5 million, according to an AL.com report.

Here are five things to know:

 

1. The 32 hospitals, including three in Alabama where one of the whistleblowers is based, agreed to pay more than $28 million to settle improper billing allegations. Altogether, more than 130 hospitals are settling with the government for more than $130 million for inpatient kyphoplasty when the procedure can be done safely in the outpatient setting.

 

2. Two former Kyphon employees were the whistleblowers. Kyphon produced the device for kyphoplasty. The men sued under the False Claims Act and were entitled to a portion of the settlement.

 

3. The two whistleblowers were a former regional sales manager and former reimbursement manager.

 

4. Since 2009, the government has recovered nearly $17 billion in fraud cases against federal healthcare programs.

 

5. At least one of the hospitals, Crestwood Medical Center of Huntsville, Ala., reported Medicare rules were unclear about when spine surgery patients can be held overnight. The hospitals did not admit wrongdoing or liability in the settlement.

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