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CHS takes the concerns of our employees very seriously. Carolinas HealthCare System takes compliance with Medicare and Medicaid regulations very seriously and our Corporate Compliance Department is dedicated to facility and physician compliance. In 20, CHS asked two separate outside consultants to review our coding process. The health system also stated, “In 2010, the Centers for Medicare and Medicaid Services (CMS) rejected the long standard American Medical Association’s CPT billing codes for drug screens in favor of its own coding system.
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It is about the interpretation and application of complex and constantly changing billing guidelines.” The lawsuit is not about our patient safety, quality of care, or whether the urine drug screen tests were done correctly.
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The laboratory director will receive $1,365,000 from the settlement.Īccording to, a Charlotte-based news station, in an online story, CHS issued a statement: “On June 30, 2017, Carolinas HealthCare System entered a civil settlement to resolve allegations in a lawsuit that, between 20 CHS billed the wrong code for drug screens reimbursed by Medicare and Medicaid. The government conducted the investigation and intervened in this action to effectuate the settlement. The act also allows the government to intervene and take over the action. Under the False Claims Act, private citizens can bring suit on behalf of the government for false claims and share in any recovery. The allegations arose from a lawsuit filed by a whistleblower, a former laboratory director for CHS, under the qui tam provisions of the False Claims Act. “As a result of CHS’s up-coding practices, the government alleges that federal health care programs paid CHS, and certain facilities under contract with CHS, approximately $80 more per test for the claims submitted with the higher paying code,” the Justice Department stated in its press release. The government alleged that CHS engaged in a practice referred to as “up-coding,” by submitting claims using code G0431, which should be used only for tests classified as “high complexity” by the FDA, instead of using code G0434, which is the code for moderately complexity tests, which triggers a payment of approximately $20.00. Claims submitted to federal health care programs include a code that identifies the services provided and that triggers a certain payment. Department of Health and Human Services, Office of Inspector General, Office of Investigations - Atlanta Region.Īccording the governments allegations and based on court documents, from 2011 to 2015, CHS conducted urine drug tests, categorized as “moderate complexity” tests by the Food and Drug Administration (FDA), but submitted claims that indicated the company had conducted “high complexity” tests. Attorney Rose made the announcement along with North Carolina Attorney General Josh Stein, and Derrick L.
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Attorney Jill Westmoreland Rose announced June 30 that the Charlotte-Mecklenburg Hospital Authority, dba Carolinas Healthcare System (CHS), has agreed pay the settlement as the government accused the health system of “up-coding” claims for urine drug tests in order to receive higher payment than allowed for the tests. In a Department of Justice press release, U.S. Charlotte, N.C.-based Carolinas Healthcare System has agreed to pay the federal government $6.5 million to resolve allegations that the company violated the False Claims Act.