By Brian Murphy

The end of last week brought news of a lawsuit that appears to have broad and deep ramifications for the CDI profession. Providence Health & Services, a 34-hospital system headquartered in Renton, Washington, has been hit with a $188.1 million lawsuit for allegedly upcoding various diagnoses, including severe malnutrition, encephalopathy, and respiratory failure.

What makes this particular suit different from prior qui tam (more commonly known as whistleblower) complaints or formal CMS/OIG audits is that this suit was brought on behalf of a data analytics firm, Austin, Texas-based Integra Med Analytics LLC. Med Analytics is demanding a jury trial on behalf of the United States under the False Claims Act.

A read of the complaint seems to show that no chart audits have been conducted, but that the weight of the lawsuit rests largely on the incidence of diagnoses reported in publicly available data, via a proprietary analysis of claims information dating back to 2011.