Health Information Management

News: Baptist Healthcare settles after claims of improper billing for sepsis, respiratory failure

CDI Strategies, September 2, 2011

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$8.9 million. That is the amount Kentucky-based Baptist Healthcare Systems, Inc., had to pay as of September 1 to settle claims of improper billing related to respiratory infections and inflammations, pulmonary edema (fluid accumulation in the lungs), respiratory failure, and septicemia (blood infections), according to a release from the Department of Justice.

The allegedly improper billing covered by the settlement agreement occurred between January 1, 2001, and December 31, 2006. The areas at issue for Baptist Healthcare have long been targets on CMS’ Program to Evaluate Payment Pattern Electronic Report (PEPPER) and more recently concerns for Recovery Audit Contractor review. The U.S. attorney says the legal claims are based on payment by mistake and unjust enrichment, however the settlement does not assign liability to Baptist Healthcare System.



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