In what can be seen as a cautionary tale for any hospital that trains residents, Dartmouth-Hitchcock Medical Center, Lebanon, N.H., has agreed to pay more than $2.2 million to settle charges that it improperly billed several federal healthcare programs, the U.S. Attorney for the District of Vermont announced yesterday. More than $80,000 of the settlement monies will be go to Vermont; $61,000, to New Hampshire; $1.5 million to the federal governmen; and more than $334,000 to Thomas Prendergast, MD, a former Dartmouth-Hitchcock physician (and Vermont resident) who exposed the improper billing.
Prendergast had reported that the hospital improperly billed federal programs--including Medicare, Medicaid, Veterans Affairs ,and the military's Tricare health insurance system--for services delivered by resident physicians in training who were unsupervised by more senior attending physicians, according to the Boston Globe. Federal regulations and guidelines do permit physicians to bill for certain services provided by residents, but those services must be performed while a physician is present and the medical record must include "appropriate documentation of the physician's presence," according a statement from the office of U.S. Attorney Tristram Coffin.
The primary source of the alleged billing problems was linked to Dartmouth-Hitchcock's anesthesiology department, including the pain clinic, and the U.S. attorney's office discovered similar billing problems in the radiology department. The office said the improper billing had occurred from 2001 through September 2007.
Despite having agreed to the settlement, the medical center continues to deny any wrongdoing. However, hospital officials say it has been working to improve its billing practices."We take documentation and billing practices very seriously and are determined to meet the highest standards of compliance and excellence in all aspects of our operations," Carl DeMatteo, MD, chief quality and compliance officer, tells the Boston Globe.