Texas health system beats $61.8M billing fraud case

A Texas federal judge dismissed a False Claims Act lawsuit alleging Dallas-based Baylor Scott & White Health overbilled Medicare by improperly upcoding claims, according to Law360.

The whistleblower lawsuit, filed in 2017, alleges Baylor Scott & White Health submitted more than $61.8 million in false claims to Medicare over a seven-year period. The allegations in the case focused on two secondary diagnosis codes: “complication or comorbidity” and “major complication or comorbidity.”

The whistleblower alleged Baylor Scott & White’s medical director for coding and utilization spearheaded the alleged scheme to overbill Medicare. He allegedly enacted a scheme to increase the number of patients whose services were coded for CCs and MCCs.

U.S. District Judge David Ezra dismissed the lawsuit because the whistleblower failed to properly state a claim for relief.

Source: Texas health system beats $61.8M billing fraud case / Becker’s Hospital Review

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