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April 2, 1998

Pitt, UPMC, practice plans agree to pay $17 million to settle charges of overbilling for Medicaire, Medicaid

Pitt, the UPMC Health System and the 18 clinical practice plans affiliated with the University's School of Medicine have agreed to pay $17 million to the federal and state governments to settle charges that Pitt physicians overbilled Medicare and Medicaid between 1990 and 1996.

The physicians' Medicare/Medicaid billings during those years totaled approximately $250 million.

The audit that led to the settlement showed no evidence of fraud or inadequate care of patients, according to government and University statements.

"The independent audit commissioned by the University of Pittsburgh only dealt with discrepancies in billing procedures; handling of paperwork was in question, not care of patients," a March 19 Pitt news release stated. "As was the case with other major academic medical centers throughout the country, the University of Pittsburgh chose to settle with the government to avoid long and costly litigation." Pitt commissioned the audit in response to an investigation that the U.S. Department of Health and Human Services (HHS) began in June 1996 to determine whether physicians at academic medical centers were following Medicare's rules for billing for patient care services, and whether those services were documented properly. So far, 49 of the country's academic medical centers are in various stages of such audits.

According to University officials, government regulations for patient billing at academic medical centers historically were ambiguous and unclear.

In 1996, the Health Care Financing Administration revised those billing standards. However, under the current HHS Department investigation, 1996 billing standards have been retroactively applied in cases dating back to 1990, Pitt officials complained.

Pitt, UPMC and the practice plans will contribute to paying the $17 million settlement. But neither those entities, nor government officials, would specify how the three would share the costs.

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