Illinois hospitals part of $250M Medicare billing settlement

CHICAGO (AP) — Several Illinois hospitals, including SSM Health St. Mary’s in Centralia and Good Samaritan Hospital in Mt. Vernon, are among nearly 500 around the country involved in a $250 million settlement with the government over Medicare billing for cardiac devices.

The eight affiliated hospitals of SSM Health Care in Illinois and Missouri will pay a total of $4.1-million of the settlement.

The U.S. Justice Department said Friday the hospitals weren’t eligible for reimbursement for the $25,000 electronic defibrillators because they were implanted in patients too soon after heart attacks or bypass surgery. Billing rules require longer waiting periods to see if heart function improves enough on its own.

The nine Illinois hospitals are affiliated with Advocate Health and Hospitals Corp. of Downers Grove and Springfield’s Memorial Health System. Together, they paid $5.7 million.

Memorial said in response that those cases were medically necessary, but that it is now following billing rules.

Advocate said its focus is on patients and it settled to avoid a legal battle.