Aurora, Colo.-based University of Colorado Health has agreed to pay $23 million to resolve allegations that it violated the False Claims Act by improperly coding certain evaluation and management claims, and submitting them to federal healthcare programs.
According to a Nov. 12 news release by the Department of Justice, from Nov. 1, 2017, through March 31, 2021, UCHealth automatically coded certain claims for emergency room visits using CPT 99285, which represents the highest hospital resource usage. It used this code whenever one of its providers checked a patient's vital signs more times than the total number of hours that the patient was in the emergency department, except patients who spent less than 60 minutes there, regardless of the severity of the patient's condition or the actual amount of resources used.
The government alleged that UCHealth knew that this coding system did not align with requirements for billing federal healthcare programs, as it did not accurately represent the facility resources being used by UCHealth hospitals.