UCHealth agrees to pay $23 million to resolve allegations of fraudulent billing during emergency visits

DENVER, Colo. (KKTV) – University of Colorado Health agreed to pay $23 million to resolve allegations of violating the False Claims Act by allegedly requesting and receiving payment from federal health care programs for emergency room visits, according to the Colorado U.S. Attorney’s Office.

The claims stated that UCHealth allegedly improperly coded a number of evaluation and management claims submitted to the Medicare and TRICARE systems.

On Tuesday, UCHealth responded to the allegations after the settlement:

“UCHealth is pleased with the conclusion of this lengthy and labor-intensive investigation. UCHealth denies these allegations, but we agreed to the settlement to avoid potentially lengthy and costly litigation. The settlement allows us to focus our resources on delivering excellent patient care.”

The U.S. Attorney’s Office said these false codings allegedly caused UCHealth to allegedly bill for a number of emergency room visits that reflected the highest use of hospital resources when that may not always have been the case.

They said that between Nov. 1, 2017, and March 31, 2021, the hospitals allegedly coded claims for emergency room visits, showing the highest use of hospital resources. Healthcare providers allegedly checked a patient’s vital signs more times than the total number of hours the patient was in the emergency room, without regard to the severity of the patient’s actual medical condition or the hospital resources used to care for the patient to help.

“Fraudulent billing by health care companies undermines Medicare and other federal health care programs that are vital to many Coloradans,” said Acting U.S. Attorney Matt Kirsch for the District of Colorado. “We will hold accountable healthcare companies that use automatic coding practices that result in unnecessary and inappropriate billing.”

The settlement included claims brought under private citizen Timothy Sanders in the case Sanders v. University of Colorado Health et al. The U.S. Attorney’s Office said Sanders received 3.91 million of the settlement proceeds.

Click here to read the full press release.