AHA, Pennsylvania association file brief in support of UPMC in overlapping surgeries case

A United States Attorney‘s Office is attempting to bootstrap the Centers for Medicare & Medicaid Services billing guidelines on overlapping surgeries into a False Claims Act case, the AHA and Hospital and Healthsystem Association of Pennsylvania argue in a friend-of-the-court brief filed yesterday in a case involving University of Pennsylvania Medical Center. The billing guidance “explicitly … permits overlapping surgeries as long as a qualified backup physician is available,” and there is no serious allegation in this case that those billing guidelines were even breached, the brief states. It notes that medical guidance on overlapping surgeries was updated by the American College of Surgeons in 2015 and CMS’ billing guidelines have largely deferred to that medical guidance since then. “This has allowed hospitals to develop policies … that are consistent with ACS guidance, and best suited to their patients’ individual circumstances and their surgical teams’ own professional experience,” the associations say. The brief further notes that the court should not permit CMS billing guidelines to be “morph[ed] into actionable fraud against the government.”