DOJ Announces Settlement with Banner Health to Settle False Claims Act Allegations

Not even 4 full months into 2018 and the qui tam (whistleblower) provisions of the False Claims Act continue to drive significant settlements between healthcare providers and the Department of Justice (DOJ),  as well as a proliferation of Corporate Integrity Agreements (CIA) .

The Banner Health case is complicated by several factors; however, it's a good example of why hospitals and health systems must conduct periodic internal audits of admission orders and clinical documentation associated with observation status. The use of observation status should be sparing and justified explicitly in the patient record by the medical providers. Misunderstandings regarding the intent and requirements of the two-midnight rule persist, causing some providers to hesitate to admit to inpatient, while observation status has become a fall back position for cases complicated by social factors and the pressure to 'do something'.