Reference no: EM133843873

Problem

The medical coding fraud case that I will be discussing this week is associated with an article by Austen Erblat of CBS News titled "UCHealth Settles Federal Fraud Case for $23M After Accusations of Fraudulent Emergency Room Billing". In this 2021 settlement case, University of Colorado Health, or UCHealth was accused of fabricating and submitting medical claims to Medicare and TRICARE with Evaluation and Management codes associated with unnecessary treatment rendered to patients. University of Colorado Health would do this by unnecessarily checking certain patients vital signs multiple times in order to meet the standards of the highest Evaluation and Management code. University of Colorado Health would also reject certain patients who were not in the emergency room for less than 60 minutes regardless of their medical needs. By doing this, University of Colorado Health took advantage of the medical coding process and was caught since it was found that the excessive checking of the patient's vital signs was unnecessary according to the type of treatment UCHealth provided. The fraudulent practices that UCHealth used were exposed by Timothy Sanders, who was protected under whistleblower standards.Timothy Sanders, former revenue recovery auditor for UCHealth, stated that multiple people within the team knew about the fraudulent practices ongoing throughout UCHealth and ultimately assisted in resolving a total of 64 cases for people who were impacted by the fraudulent practices of UCHealth. UCHealth violated the False Claims Act and was required to pay $23 Million in settlement charges. Get the instant assignment help. Since the case was settled, there is no determination of the practice being innocent in this matter. $3.91 million of the settlement funding was paid to Timothy Sanders for his efforts in exposing the treatment that UCHealth provided to patients for their own financial benefit.

What are some of the key take aways from this article?