Kauai hospital settles billing
dispute for $1.5 million

Wilcox Memorial Hospital denies
any wrongdoing alleged in
the Medicare inquiry

---

Star-Bulletin staff

Wilcox Memorial Hospital on Kauai paid more than $1.5 million to the federal government because of alleged overbilling, according to U.S. Attorney Ed Kubo, Jr.

The settlement follows a two-year investigation into billing for Medicare, a federal health care program for senior citizens, and Tricare, a program that provides benefits to military dependents.

Under the terms of a settlement finalized Friday, the hospital paid $1,521,428.28 and agreed to abide by a corporate integrity plan, including periodic audits and maintaining a hotline for the reporting of allegations of fraud and abuse, for a three-year period.

Wilcox denied the allegations and did not admit any wrongdoing.

"We have worked diligently with the Department of Justice and the Office of Inspector General and found that the documentation issues were not intentional and did not compromise clinical care," spokeswoman Lani Yukimura said.

The investigation began as part of a nationwide initiative that focused on claims for pneumonia patients but was broadened in Wilcox's case to include other categories of claims covering billing from 1995 through 1998. The government alleged that the claims filed by the hospital were not adequately supported by the patient's medical records.

"Wilcox's willingness to address this matter forthrightly contributed to a resolution that is fair and appropriate," Kubo said in a news release.

Hospital officials said they have tightened up monitoring and made a commitment to "additional training regarding compliance and with increasingly complex rules and regulations governing the delivery of health care," Yukimura said.

"We have significantly expanded our already existing compliance program and created new processes, as well as made some staffing changes that will prevent such mistakes from happening again," she said. "Our objective is to prevent errors from reoccurring and to detect and promptly correct any that do."