DENVER (KDVR) — UCHealth agreed to repay $23 million received from federal healthcare programs after allegations that the hospital violated the False Claims Act for visits to its emergency departments.
According to the U.S. Attorney’s Office for the District of Colorado, UCHealth was falsely coding certain “Evaluation and Management” claims submitted to the Medicare and Tricare programs. The prosecutors said that E&M claims relate to visits that involve evaluation and managing health conditions and include qualifying visits to an emergency department.
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Hospitals can use one of five Current Procedural Terminology codes to classify the visits based on hospital resources used, the U.S. Attorney’s Office said, and an E&M claim coded with CPT 99285 represents the highest usage of hospital resources.
The U.S. alleged that between Nov. 1, 2017, and March 31, 2021, UCHealth hospitals “automatically” used CPT 99285 for some emergency room visits.