Higher education

Inspector general investigating University of Iowa Health Care

Questions emerge around 'possible false or otherwise improper' Medicare and Medicaid claims

University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo taken on Friday, April 18, 2014, in Iowa City, Iowa. (Justin Wan/The Gazette-KCRG TV9) ¬
University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo taken on Friday, April 18, 2014, in Iowa City, Iowa. (Justin Wan/The Gazette-KCRG TV9) ¬

The University of Iowa Hospitals and Clinics is “cooperating fully” with an Office of Inspector General investigation into “possible false or otherwise improper” Medicare and Medicaid claims.

The U.S. Department of Health and Human Services office sent UIHC Chief Executive Officer Ken Kates a letter April 11 ordering he produce a long list of documents — including medical records for nine pages of beneficiaries of Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program.

In total, the office ordered the university provide records related to 34 numbered items focused on federal health care program claims, the university’s electronic health record software, patient questionnaires, patient system checks, and revenue generated by physicians, according to the Inspector General’s letter, obtained by The Gazette through a public records request.

The subpoena also requested personnel files for six individuals, including Jean Robillard, vice president for medical affairs of UI Health Care and dean of the Carver College of Medicine.

UIHC spokesman Tom Moore said the investigation is ongoing, as is the university’s response to the subpoena, which requested documents dating back to Jan. 1, 2000. He also said the university is not in a position to speak for the Office of Inspector General about the nature of the investigation.

“The University of Iowa is cooperating fully with the OIG’s review and remains committed to full compliance with all applicable laws, rules, and regulations,” Moore said in a statement.

Katherine Harris, spokeswoman for the Office of Inspector General, confirmed for The Gazette her office is part of the investigation of UI Health Care — a $1.9 billion enterprise that includes the UI Hospitals and Clinics, a 728-bed facility that boasts more than 12,000 employees, students, and volunteers and annually admits more than 33,000 patients for inpatient care.

Harris said her office can’t comment further, as the investigation is ongoing.

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Jeffrey Thompson, solicitor general in the Iowa Attorney General’s Office, sent a letter to the state’s Executive Council on May 26 requesting special counsel to assist the university in its response to the subpoena.

“UI recently received a subpoena from the U.S. Department of Health and Human Services Office of the Inspector General related to the health care operations of UI Health Care,” according to Thompson’s letter.

He said the university wants to retain Chicago-based McDermott, Will & Emery LLP at a cost of $55 an hour for project attorneys; $240 an hour for process management attorneys; $830 for senior regulatory counsel; and $895 an hour for litigation counsel.

The university will make those payments directly, according to Thompson. Moore said project costs to date have not been compiled.

Thompson said the university specifically requested McDermott, Will & Emery because it has specialized knowledge about Office of Inspector General investigations and has worked with UI Health Care before.

“MWE’s services will aid UI in providing a timely and methodically accurate response to the subpoena,” according to Thompson’s letter.

Specific requests listed in the subpoena include:

Documents relating to the decision to adopt, implement, purchase, and use the electronic health record software program manufactured by EPIC;

Documents related to implementation of EPIC and concerns and complaints about EPIC;

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Documents related to the decision to require patients to complete a questionnaire before or during an encounter with a physician or medical professional;

Documents related to the decision to incorporate patient questionnaires into EPIC;

Documents related to using, incorporating, or considering responses to patient questionnaires as part of “evaluation and management services,” which relates to medical record documentation, billing, and coding guidance out of the Centers for Medicare and Medicaid Services.

Documents related to concerns or complaints about using, incorporating, or considering patient questionnaire responses as part of evaluation and management services;

Documents related to concerns and complaints about the decision to require physicians to complete “patient system checks” as part of evaluation and management services;

Documents identifying the person or people responsible for making that decision;

Documents tracking, reflecting, observing, or commenting on revenue productivity of and revenue generated by physicians;

And documents related to any internal or external audit or investigation regarding use, misuse, or concerns around EPIC or billing and coding for evaluation and management services.

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The Office of Inspector General has in the past reviewed the UIHC for Medicare compliance. According to a 2012 report, Medicare paid the UI hospitals about $659 million for 515,751 outpatient and 31,110 inpatient claims for beneficiaries during 2009 and 2010. The office’s audit covered $5.2 million in Medicare payments for 321 outpatient and 77 inpatient claims identified as “potentially at risk for billing errors,” according to the report. Of those claims, investigators found the hospital complied with Medicare billing requirements for 124 — or 31 percent.

“The hospital did not fully comply with Medicare billing requirements for the remaining 274 claims, resulting in overpayments totaling $826,104 for (calendar years) 2008 through 2011,” according to the report.

Specifically, 245 outpatient claims contained billing errors, resulting in overpayments amounting to $590,539, and 29 inpatient claims had billing errors, resulting in net overpayments of $235,565, according to the report.

“These errors occurred primarily because the hospital did not have adequate controls to prevent incorrect billing of Medicare claims,” according to the report.

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