- Late Monday afternoon, Tennessee-based Community Health Systems and the Department of Justice announced that CHS will pay $97M plus interest in settlement to the federal government. The suit alleged that CHS habitually admitted patients who should have been treated on an out-patient basis in order to bill Medicare at the higher inpatient rates.
- The settlement found "no improper conduct by Community Health Systems or its affiliated hospitals, and the Company has denied any wrongdoing," said CHS in a statement. The hospital chose to settle out of a desire to end the ongoing—and expensive—investigation by the DOJ, which began in 2011.
- The whistleblowers, including ED physicians and case managers, say that further investigation is needed to improve patient safety and care at CHS. They allege that the hospital created standards for admission to improve profitability, providing "medically unnecessary" care.
Matt Organ, partner at Goldberg Kohn, the law firm representing the two of the whistleblowers, also hinted at alleged corporate pressure on physicians to meet the more profitable internal benchmarks for admittance. "I think that there are a number of people in the healthcare industry who have a growing concern about corporate pressure influencing medical decision-making," Organ told Modern Healthcare. "I think when this case gets a little bit of attention, people might recognize this may be happening at their medical facility and give them the courage to come forward."
CHS continues to maintain that its physicians and management behaved properly.
"The question of when a patient should be admitted to a hospital is, and always has been, a matter of medical judgment by the individual physician responsible for a patient's care," said CHS CEO Wayne Smith in a statement. "Unfortunately, shifting and often ambiguous standards make it extremely difficult for physicians and hospitals to consistently comply with the regulations. We are committed to doing our best, despite these challenges."
The settlement also addressed allegations of self-referrals to CHS' Laredo Medical Center in Texas and the provision of inappropriate cardiac and hemodialysis services.