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

DENVER, Colo. (KKTV) - The University of Colorado Health agreed to pay $23 million to resolve allegations of violating the False Claims Act by allegedly seeking and receiving payment from federal healthcare programs for visits to emergency departments, according to the Colorado U.S. Attorney's Office.

The claims said UCHealth allegedly falsely coded some Evaluation and Management claims, which were submitted to Medicare and TRICARE systems.

The U.S. Attorney's Office said, through these false codings, UCHealth allegedly billed some ER visits depicting the highest hospital resource usage when that may not have always been the case.

They said between Nov. 1, 2017, and March 31, 2021, the hospitals reportedly coded claims for emergency room visits depicting the highest hospital resource usage. Healthcare providers allegedly checked a patient's vitals more times than the total number of hours the patient was in the ER, disregarding the severity of the patient's actual medical condition or hospital resources used to help the patient.

"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 health care companies who adopt automatic coding practices that lead to unnecessary and improper billing."

The settlement included claims brought under private person Timothy Sanders in Sanders v. the University of Colorado Health et al. The U.S. Attorney's Office said Sanders received 3.91 million of the settlement's proceeds.{/p/p}