Federal health officials are investigating allegations of overcharging for Medicare patients by the chief emergency room physician at Scripps Memorial Hospital in La Jolla.
A spokesman for the inspector general’s office at the Department of Health and Human Services in Washington confirmed the investigation Monday.
Judy Holtz said that the department’s review of information being provided by Scripps could require six months before any findings are released. She said that evidence could be submitted to the U.S. Justice Department for criminal prosecution or could be handled administratively within the department, depending on the severity of any wrongdoing that might be uncovered.
Scripps officials notified federal health officials in August of suspected overcharging for services to Medicare patients treated in the hospital’s emergency room. The doctor who handled emergency room doctors and all billings under a contract with Scripps is on an indefinite leave of absence.
The contract between Dr. Robert J. Eggold and Scripps was canceled Aug. 21 by the hospital after its officials learned of possible billing irregularities. Eggold operated the Emergency Care Medical Group Inc., which also had contracts to operate emergency rooms at Mission Bay and El Centro Community hospitals.
Scripps officials are cooperating fully with federal officials, communications director Michael Bardin said, and have turned over all records of Medicare patients treated in the emergency room whose billing was handled by Eggold. Bardin said that Scripps officials do not yet know the number of patients nor the dollar amount that allegedly was overcharged, but added that the amount could run into six figures.
Scripps took the bills that Eggold submitted and passed them along to federal authorities for payment, later receiving the money and reimbursing Eggold. Bardin said that the hospital has changed its procedures for checking the accuracy of bills submitted for payment by emergency room physicians.
“And all billing now comes to us directly from individual doctors,” Bardin said.
Bardin said the federal investigation should establish the specific means by which the hospital’s auditing system was superseded by the alleged overcharging.
“We don’t even know yet; that’s at the heart of the investigation,” Bardin said. However, he said that Scripps is “almost 99% certain” that no hospital employees were involved in any overcharging. “We’ve looked at all the records ourselves before turning them over to the inspector general,” Bardin said.
A spokesman at Mission Bay Community Hospital said that individual emergency room doctors submit their own billings and none was handled through Eggold. Ted Storer said the hospital also did an internal audit after the allegations became known at Scripps and found no problems.
A spokesman at El Centro Community Hospital failed to return several phone calls about the matter.