Data initiative leads to hospital infusion settlements

The OIG continues to settle cases involving hospital outpatient facilities that bill, or were paid separately, for injections/infusions when the same services were already covered by another billing code paid on the same date of service. Injections and infusions are included in an emergency room service charge and are not reimbursed separately.

The cases are part of a data-led initiative involving the OIG’s Fraud, Waste and Abuse Research and Analytics team, Litigation, and Investigations and Reviews. The following cases were settled this quarter:

• In April, a settlement was reached with a Fort Worth hospital. The provider had been improperly reimbursed for administering injections and infusions in the outpatient emergency department. The case centered on billing from 2013 to 2019. The provider worked collaboratively with OIG Litigation to resolve these issues and agreed to a settlement of $7,956,904.
• The OIG settled a case in May with a Dallas hospital that was improperly reimbursed for the administration of injections and infusions in the outpatient emergency department. The provider worked collaboratively with the OIG to resolve the issues and agreed to a settlement of $10,155,285 for billing from 2013 to April 2021.
• The OIG settled a case in May against a Plano hospital for injection and infusion billing from 2013 to April 2021. The provider had been improperly reimbursed for the administration of injections and infusions in the outpatient emergency department. The provider worked collaboratively with OIG Litigation to resolve these issues and reached a settlement of $1,211,913.
• An outpatient hospital in Mesquite was improperly reimbursed for administering injections and infusions in the outpatient emergency department. The billing issues took place between 2012 and 2019. The provider collaborated with OIG Litigation to resolve these issues and in May agreed to a settlement of $130,783.