Arizona, Banner Health To Pay Over $18 Million To Settle False Claims

PHOENIX – Banner Health has agreed to pay the United States over $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis, the United States Attorney’s Office for the District of Arizona announced today. Headquartered in Arizona, Banner Health owns and operates 28 acute-care hospitals in multiple states.

The settlement resolves allegations that 12 Banner Health hospitals knowingly overcharged Medicare patients unnecessarily. In particular, the United States alleged that from November 1, 2007, through December 31, 2016, Banner Health billed Medicare for short-stay, inpatient procedures provided at the 12 hospitals that should have been billed on a less costly outpatient basis. The settlement also resolves allegations that Banner Health inflated in reports to Medicare the number of hours for which patients received outpatient observation care during this time period.

“Taxpayers should not bear the burden of inpatient services that patients do not need,” said Acting Assistant Attorney General Chad A. Readler for the Justice Department’s Civil Division. “The Department will continue its efforts to stop abuses of the nation’s health care resources and to ensure that patients receive the most appropriate care.”

“This enforcement action is another example of this office’s commitment to protecting the Medicare program,” said Elizabeth A. Strange, First Assistant United States Attorney for the District of Arizona. “The United States Attorney’s Office, working with our law enforcement partners, will continue to protect Medicare by aggressively pursuing False Claims Act allegations of wrongdoing in the health care industry.”

“Hospitals that bill Medicare for more expensive services than are necessary will be held accountable,” said Christian J. Schrank, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Medical decisions should be made based on patients’ conditions and needs, not on providers’ profits.”

Banner Health also entered into a corporate integrity agreement with the U.S. Department of Health and Human Services – Office of Inspector General (HHS-OIG) requiring the company to engage in significant compliance efforts over the next five years. Under the agreement, Banner Health is required to retain an independent review organization to review the accuracy of the company’s claims for services furnished to federal health care program beneficiaries.

This settlement resolves a lawsuit filed in the United States District Court for the District of Arizona by Cecilia Guardiola, a former employee of Banner Health, under the qui tam or whistleblower provisions of the False Claims Act, which permit private citizens to bring lawsuits on behalf of the United States and obtain a portion of the government’s recovery. Ms. Guardiola will receive roughly $3.3 million.

5 Comments on "Arizona, Banner Health To Pay Over $18 Million To Settle False Claims"

  1. The Oracle of Tucson | April 13, 2018 at 6:15 am | Reply

    While many see a hospital as a place to receive medical attention, as a business, Banner only sees it as a place to make money.
    It should come as no surprise to anyone that Banner is in it for the money and little else. Without government mandated health coverage, there is risk, with government mandated health coverage there is money to be made, without such assurances Banner could never have raised the capital to buy everything in sight to corner the market.
    The poultry $18 million in fines is nothing compared to revenue. The fines only came from being caught.
    Banner reported total system operating income of $157.1 million on revenue of $7.63 billion in 2016. That compared with 2015 operating income of $128.4 million on revenue of $6.97 billion, so what’s $18 million but a cost of doing business in 2018?

    The Oracle

  2. hell, $8 mil came from Pima country taxpayers ….that’s wht lord chuckles gives them every year last I hear…

  3. Richard Hernandez | April 13, 2018 at 8:57 am | Reply

    U of A., Sold it soul for money.

    Banner is not willing to care for us the people. The only care you get is if you have INSURANCE.

    No shock there…it just like our Governor and Legislature there only love is dollars.

    Sound like biblical character, Judas. Money is root of all evil. If in doubt look at state of affairs more Arizona residents it all about? You got it, money money money.

    Richard Hernandez

    • Heather Dale | April 13, 2018 at 9:26 am | Reply

      The Bible doesn’t say money is the root of all evil. It says the LOVE of money is the root of all evil. Money by itself does no harm.

  4. Watching one palm grease the other... | April 14, 2018 at 1:14 pm | Reply

    FINALLY! I had called Medicare and filed a complaint of pushing terminally ill patients to Health South for rehabilitation. My example: My mother had a brain tumor that went UNDIAGNOSED for over a year. We had asked for help because of her hallucinations and odd behaviors. When I finally took her to UMCKino after I found her on the floor post seizure they did an xRay and saw an egg sized tumor(glioblastoma) sitting in her frontal lobe right in the middle. So fast forward to the scam. She had had a bx in UMC BANNER and the neurosurgeon agreed with the original diagnosis. 3 months was the time till she would be gone. well, bring in discharge planning. A representative from UMC brought a representative from the rehab place–Health South– They were trying to push her to rehab. UMC tried to push her out of the hospital also with 103 degree temperature and pneumonia. I called the advocate and refused to let them discharge her without at least antibiotics for her pneumonia. So in the meantime Health South and the discharge planner were still pushing to go to health south. I finally sat them down in the room and told them what I thought was going on. well, I was right because the looks on their faces and the glances between them were so obviously telling of the medicare dollars that were flowing between the 2 institution. Health South pays for UMC BANNER to funnel patients to them. Banner sends terminally ill patients to them for the 10 days that medicare initially will pay. They then will continue to pay as long as the charting will show progress. My mom was on to them too. I insisted she go to Handmaker’s. She was placed on hospice status 3 days after going to Handmaker’s due to her deterioration. She passed away exactly 3 months to the day she was diagnosed. BUT I’m glad I reported them to the FRAUD department. She had been in a 3 bed room at Banner UMC. Her roommates were all funneled to Health South. At least 6 different people. 5 of them were Medicare patients. I feel like 18 million isn’t enough.

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