St. Francis reaches agreement with feds on kyphoplasty billings

INDIANAPOLIS – St. Francis Hospital & Health Centers has reached a settlement with the U.S.Department of Justice regarding the billing of kyphoplasty procedures performed at its Beech Grove and Indianapolis campuses from 2002 to 2005.

The settlement is part of a nationwide investigation of hospitals regarding kyphoplasty billing practices. St. Francis will pay Medicare $3.15 million for those cases that did not meet the criteria for inpatient admission.

Upon being notified of the investigation, St. Francis cooperated fully with the government and took immediate action to investigate its practices. It is important to note that the probe had nothing to do with quality of care, patient safety or medical necessity, hospital officials emphasized.

The focus of the investigation was on the lack of documentation to support the treatment in an inpatient setting.

Kyphoplasty is a minimally invasive spinal procedure used to treat painful, progressive vertebrae compression fractures. It involves using a balloon-type device to restore the height and shape of the affected vertebrae, followed by using a strengthening bone cement.

In August 2008, St. Francis was notified by the Department of Justice that it was part of a nationwide investigation related to a lawsuit brought against Kyphon Inc. The suit alleged that Kyphon encouraged hospitals and physicians to perform kyphoplasty as an inpatient procedure, when an outpatient setting may, in some cases, have been more appropriate.

Regardless of whether the procedure was provided in the inpatient or outpatient setting, all patients who had the procedure performed at St. Francis received appropriate, medically necessary and high quality care, hospital officials emphasized.

St. Francis is a non-profit health care organization focused on its mission of providing quality and compassionate health care services to the community.

“St. Francis Hospital is committed to compliance with all federal and state health-care regulations. We have taken the necessary steps and implemented new policies to ensure compliance and to prevent similar incidents from occurring,” said Robert J. Brody, St. Francis president and chief executive officer.