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Rounds With Ray
What was the principal issue involved in the lawsuit? The plaintiffs alleged that UMA and the Medical University incorrectly billed for physician services. One of the major types of incorrect billing claimed was for services rendered when the attending physician was not present. Who were the plaintiffs? The suit was brought initially by four former employees of either UMA or the Medical University. The federal government joined the suit on the billing issues, leaving a claim of wrongful termination of employment to be addressed separately with the former employees. What was the outcome of the lawsuit? At the encouragement of the presiding judge, the parties entered into discussions about reaching a fair and equitable resolution. Two settlements were reached. The first related to the billing issues, for which a sum of $5.2 million to be paid over five years was negotiated with the U. S. attorney. A separate settlement of a one-time payment of $500,000 on the wrongful termination was negotiated with the four former employees. Do the UMA and the Medical University have to pay any additional expenses? Yes. In addition to paying the legal fees of the counsel who represented UMA and the Medical University, payment of fair fees for the legal counsel for the four former employees also will be required. The final bill for these expenses has not been submitted and will require approval by the presiding judge before this amount is determined. Who will make the payments? Since the allegations relate to physician and hospital billings that are handled through UMA and the Medical Center, respectively, those organizations will be responsible for the payments. Were the UMA and the Medical University found to be guilty of the allegations? No. UMA and the Medical University denied and continue to deny any guilt on fraudulent billing or wrongful termination. During the ten-year billing period in question, the combined hospital and physician billings to the federal government exceeded $2 billion. At a comparatively modest return payment by UMA and the Medical University, this matter is resolved between the parties without any finding of guilt. If the UMA and the University were not guilty, why did they settle? UMA and the Medical University considered the merits of pursuing both the billing and employment termination allegations through litigation. This would have entailed considerable expense in legal fees, and equally important, would have been a continuing distraction from our core business of educating health care professionals, conducting research, and providing patient care. In the final analysis, a prompt resolution with a modest payment was deemed to be the best course. In addition, the settlement assures resolution with the federal government on the issues raised for a 10-year period of time. Does the settlements resolve all of the issues in question? The settlements resolve virtually all of the issues raised. The government reserved the right to have its intermediary investigate further whether some billings were inappropriately made in duplicate. Also, the government has reserved the right to further administrative review of 11 specific clinicians. Will any other state governmental authorities review the settlement? Yes. The South Carolina Budget and Control Board reviewed and approved the settlement on April 11. Have other academic health centers faced similar situations? Yes. A number of institutions have reached settlements with the federal government over health care billing questions. For example, the University of Pennsylvania settled for $30 million, the University of Texas at San Antonio settled for $18 million, and the University of Pittsburgh settled for $17 million. What will be done to prevent a similar situation from occurring here in the future? When national attention was first focused on billing issues several years ago, UMA and the Medical University introduced a compliance program. This program is targeted at assuring that billings are correct, and involves reviews for accuracy prior to and following billings. The settlement agreement requires UMA and the Medical University to further enhance its compliance program, including regular assessment by an outside consultant and annual reports to the federal government. I hope that this information is helpful to you. If you have questions
about any aspect of this situation, please do not hesitate to let me know.
In the meantime, I trust that all members of the Medical University family
can draw some comfort from the knowledge that we can address our energies
to the reasons that brought us all to this institution
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I
am pleased to write again with an update on items of interest to the university
community. Much has transpired during the past month. One of the principal
accomplishments was the settling of a lawsuit concerning billing practices
for physician services. I thought that it would be helpful to answer some
questions that you might have about the lawsuit.