Oroville Hospital, located in Oroville, California, has agreed to pay $10,250,000, to the United States and the State of California to resolve allegations that it knowingly submitted false claims to Medicare and Medicaid arising from medically unnecessary inpatient hospital admissions, a kickback and physician self-referral scheme and the use of erroneous diagnosis codes. Oroville Hospital will pay $9,518,954 to the federal government and $731,046 to the State of California. The United States alleged that Oroville Hospital admitted patients and billed Medicare and Medicaid for more expensive inpatient hospital stays when inpatient care was not medically necessary and observation status or outpatient care was appropriate.
The United States also alleged that Oroville Hospital illegally incentivized inpatient admissions by paying financial bonuses to doctors who worked full time at the hospital and were in a position to influence whether or not patients were admitted to the hospital. The bonuses paid by Oroville Hospital took into account the volume or value of admissions by these physicians. Oroville Hospital further allegedly submitted claims to Medicare and Medicaid that included false diagnosis codes for systemic inflammatory response syndrome (SIRS), resulting in excessive reimbursement to the Hospital.
