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September 28, 2020

Lakeway Regional Medical Center, LLC, together with affiliated parties Surgical Development Partners LLC, Surgical Development Partners of Austin Enterprises LLC, G. Edward Alexander, Frank Sossi, and John Prater, will pay $15.3 million to resolve allegations under the False Claim Act arising from the development of the hospital.  Defendants were alleged to have made numerous false statements in applying for a federally-insured mortgage loan for construction of the hospital, including overstating physician support for the hospital and understating other credit risks.  Specifically, while some investors had requested refunds, defendants delayed making those refunds in order to overstate cash on hand, and, after the mortgage funds were obtained, defendants distributed them in contravention of FHA requirements.  The hospital later defaulted on the loan. The government previously settled with other defendants.  DOJ 

September 28, 2020

Lakeway Regional Medical Center, LLC will pay $1,119,177 to resolve allegations that the hospital submitted false claims to the Medicare and Medicaid programs in the form of claims for payment for services that were based on referrals from doctors offered investment in a joint venture to purchase and then lease the hospital back to LRMC.  The government alleged that such an arrangement was unlawful under the Anti-Kickback Statute.  The case was initiated by a qui tam complaint filed by Dr. Robert Van Boven and Sharon Van Boven.  USAO WD TX

November 15, 2019

California healthcare system Sutter Health, its hospital the Sutter Memorial Center Sacramento, and the Sacramento Cardiovascular Surgeons Medical Group, Inc., will pay a total of $43.12 million to resolve allegations that the entities violated the Stark Law and improperly double-billed Medicare.  Specifically, Sutter Memorial will pay $30.5 million to resolve charges of wrongfully billing Medicare for services referred to the hospital by Sac Cardio, with whom the hospital maintained improper financial arrangements that overcompensated the Sac Cardio physicians.  In addition, Sutter will pay $15.12 million to resolve allegations that it paid physicians compensation at rates that exceeded fair market value, leased office space to them at below-market rates, and reimbursed them for expenses at inflated rates.  In addition to the Stark Law violations, the settlement also resolved allegations that Sac Cardio submitted duplicative bills for physician assistant services (Sac Cardio will pay $500,000 to resolve these claims), and allegations that several Sutter ambulatory surgical centers had double-billed Medicare for radiological services that had actually been provided, and billed for, by a separate entity.  DOJ reported that allegations against Sutter Memorial and Sac Cardio were first made in a qui tam lawsuit brought by Laurie Hanvey, who will receive $5.9 million from the settlement, and that Sutter Health self-disclosed other conduct at issue in the settlement. DOJ; USAO ED Cal; USAO ND Cal

November 13, 2019

Vibra Healthcare, LLC and related entities, which operate freestanding acute medical rehabilitation hospitals and long term acute care hospitals nationwide, will pay $6.25 million to resolve allegations that Highlands Rehabilitation Hospital in El Paso, Texas, which was operated by Vibra, submitted false claims to Medicare.  Specifically, Vibra was alleged to have billed for services that did not meet conditions of payment, including requirements that inpatient rehabilitation facilities provide an intensive level of services to patients.  The case was initiated by a qui tam complaint filed by Thomas A. FlorenUSAO WDTex

November 8, 2019

Lenox Hill Hospital and its corporate parent, Northwell Health, Inc., have agreed to pay $12.3 million for violating the Stark Law and False Claims Act in submissions to Medicare.  From 2013 to 2018, Lenox Hill paid the chair of its urology department, Dr. David Samadi, a salary and bonus that improperly took into account the value of his referrals and grossly exceeded fair market value.  In an effort to maximize revenue-generating surgeries, Samadi was repeatedly scheduled to perform overlapping surgeries, leaving patients with unsupervised medical residents in violation of both hospital and Medicare rules.  The department also billed Medicare for minor procedures performed in operating rooms with an unnecessarily full operating room staff.  USAO SDNY

September 26, 2019

The Biomedical Research Foundation of Northwest Louisiana, together with related entities and the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College, which operate University Health Hospital in Shreveport, Louisiana, will pay $530,000 to resolve claims that they submitted improper claims for implantable automatic defibrillators.  To be reimbursed for the procedures, Medicare requires providers and hospitals to submit data regarding them to a qualified registry, so that the procedures can be further studied; University Health Hospital failed to make the required data submissions.  The investigation was initiated by a qui tam lawsuit filed by a whistleblower under the False Claims Act.  USAO WD LA

September 19, 2019

Selma, Alabama hospital Vaughan Regional Medical Center, together with two of its ER physicians and an affiliated company, will pay $1.45 million to resolve allegations that they violated the False Claims Act by having medical residents who were not fully licensed and credentialed provide emergency room services.  The hospital then falsified medical records and submitted claims to Medicare as if the services had been provided by a licensed physician.  The case originated with a qui tam action filed by Dr. Samuel Clemmons, who will receive $275,000.  USAO SD AL

September 13, 2019

Texas hospital administrator Starsky Bomer was convicted of violating the Anti-Kickback Statute and conspiring to commit healthcare fraud for paying kickbacks to group homes and others in exchange for referrals to outpatient treatments for severe mental illness at his affiliated hospital, resulting in $16 million dollars of false claims to Medicare. The kickbacks came in the form of salary payments and payments for transportation to owners of group homes. Mr. Bomer was sentenced to ten years in prison for his involvement in the scheme. DOJ

July 24, 2019

Pennsylvania-based Eagleville Hospital has agreed to pay $2.85 million to settle allegations of defrauding Medicare, Medicaid, and the Federal Employees Health Benefits Program.  According to an anonymous relator, Eagleville violated the False Claims Act between 2011 and 2018 by submitting claims for substance abuse patients improperly admitted for high paying, hospital-level detoxification treatments.  The whistleblower will receive $500,000 of the recovery.  USAO EDPA
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