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Baylor Scott & White Defeats Medicare Coding Fraud Claims

May 28, 2020, 3:12 PM

A whistleblower failed to sufficiently allege that Baylor Scott & White Health and affiliates submitted nearly $62 million in fraudulent claims to Medicare in violation of the False Claims Act, the Fifth Circuit said Thursday.

Integra Med Analytics LLC’s complaint lacked adequate detail to show that the defendants used improper diagnosis codes to increase reimbursement for treating patients at their hospitals, the U.S. Court of Appeals for the Fifth Circuit affirmed in a nonprecedential decision.

Integra Med’s statistical analysis suggests that Baylor may have been “ahead of the healthcare industry” with regard to how it implemented Medicare reimbursement guidelines, the...

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