Archive

September 4, 2015

Columbus Regional Healthcare System and Dr. Andrew Pippas agreed to pay more than $25 million to resolve allegations they violated the False Claims Act by submitting claims in violation of the Stark Law. The settlement also resolves allegations that Columbus Regional and Pippas submitted claims for payment to federal health care programs that misrepresented the level of services they provided. According to the government, between 2003 and 2013, Columbus Regional provided excessive salary and directorship payments to Pippas that violated the Stark Law. The government further alleged Columbus Regional submitted claims to federal health care programs for services at higher levels than supported by the documentation. The allegations first arose in two whistleblower lawsuits filed former Columbus Regional executive Richard Barker under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act. Barker will receive a yet-to-be-determined whistleblower award. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

August 13, 2015

Two Southwest Missouri health care providers agreed to pay $5.5 million to settle allegations they violated the False Claims Act by engaging in improper financial relationships with referring physicians. The two providers are Mercy Health Springfield Communities (formerly known as St. John’s Health System Inc.) and its affiliate, Mercy Clinic Springfield Communities (formerly known as St. John’s Clinic). Specifically, the government charged the hospitals with submitting false claims to Medicare for services rendered to patients referred by physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals of patients to the clinic. The allegations first arose in a whistleblower lawsuit filed by Dr. Jean Moore, a physician who is employed by one of the defendants, under the qui tam provisions of the False Claims Act. Dr. Moore will receive a whistleblower award of $825,000. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

August 12, 2015

Oswego Hospital will pay $1,456,457.33 to resolve False Claims Act charges stemming from healthcare billing improprieties the hospital self disclosed to the federal government. Dr. Vilas Patil, a physician formerly working as an independent contractor with Oswego, paid $204,365.97 to resolve False Claims Act liability in connection with a related investigation. Specifically, Oswego identified claims that were paid by federal and state payors where the supporting medical record documentation: (1) was not created or could not be located; (2) contained incorrect service dates; (3) were simply verbatim treatment notes from prior appointments with patients; and/or (4) failed to include time-related information required for certain time-based billing codes. DOJ

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud,

June 30, 2015

Community Health Network agreed to pay $20,324,902.22 to resolve allegations it violated the False Claims Act by submitting false claims to the Medicare and Medicaid programs. According to the government, since the late 1990s through October 2009, CHN had contracts with free-standing ambulatory surgery centers under which they would provide out-patient surgical services to CHN patients. CHN would then bill Medicare and Medicaid for the surgical services through the billing departments of its hospitals so it could improperly receive higher reimbursement rates. DOJ

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud,

June 29, 2015

John Muir Health agreed to pay $550,000 to resolve allegations it submitted false claims for Medicare reimbursement by failing to have physicians adequately supervise the delivery of radiation therapy services. The allegations originated in a whistleblower lawsuit filed by a former John Muir Health employee under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of $110,000 as her share of the government’s recovery. DOJ

Tagged in: FCA Federal, Hospital Fraud, Improper Medical Personnel, Whistleblower Case, Whistleblower Rewards,

June 15, 2015

Children’s Hospital, Children’s National Medical Center Inc. and its affiliated entities agreed to pay $12.9 million to resolve allegations they violated the False Claims Act by submitting false cost reports and other applications to the components and contractors of the Department of Health and Human Services, as well as to Virginia and District of Columbia Medicaid programs. The allegations first arose in a whistleblower lawsuit filed by former Children’s National Medical Center employee James A. Roark Sr. under the qui tam provisions of the False Claims Act. Mr. Roark will receive a whistleblower award of $1,890,649.98. DOJ

Tagged in: FCA Federal, FCA State, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

June 9, 2015

Earnest Gibson III, the former president of Riverside General Hospital, Earnest Gibson IV, the operator of Devotions Care Solutions, a Riverside satellite psychiatric facility, and Regina Askew, the owner of Safe and Sound group home, were sentenced to 45 years, 20 years and 12 years in prison, respectively, for their roles in a $158 million Medicare fraud scheme. They were also ordered to pay restitution in the amount of $46,753,180, $7,518,480 and $46,255,893 respectively. According to the evidence, the defendants had patients sit around the facility watching movies while they received no treatment, ultimately billing Medicare more than $158 million for care that was never provided. DOJ

Tagged in: Hospital Fraud, Medical Billing Fraud,

June 4, 2015

Hospital operator Health Management Associates (HMA) and Georgia-based hospital Clearview Regional Medical Center agreed to pay $595,155 to settle charges they violated the False Claims Act through an illegal kickback scheme. Clearview was previously named Walton Regional Medical Center and owned by HMA during the time period relevant to the lawsuit. Clearview is now owned by Community Health Systems which purchased HMA in January 2014. According to the government, HMA’s Walton Regional Medical Center paid kickbacks to Hispanic Medical Management (d/b/a Clinica de la Mama), in return for Clinica’s agreement to send pregnant women to Walton Regional for deliveries paid for by Medicaid, in violation of the federal Anti-Kickback Statute. As part of the settlement, HMA and Clearview will pay the State of Georgia an additional $396,770 to settle Georgia’s claims under the Georgia False Medicaid Claims Act. The allegations originated in a whistleblower lawsuit filed by former Walton Regional CFO Ralph D. Williams under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of $119,031. DOJ, GA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

May 21, 2015

Mohammad Khan, the former assistant administrator of Riverside General Hospital, was sentenced to 40 years in prison and to pay restitution in the amount of $31,321,200 for his role in a $116 million Medicare fraud scheme. He previously pled guilty to his role in the scheme. According to admissions made in connection with his guilty plea, from January 2008 through February 2012, Khan and others at Riverside General Hospital operated a scheme to defraud Medicare by submitting claims for partial hospitalization program (PHP) services that were not medically necessary and, in some cases, never provided. Khan also admitted he and his co-conspirators paid kickbacks to patient recruiters and to owners and operators of group care homes in exchange for which those individuals delivered ineligible Medicare beneficiaries to the hospital’s PHPs. To date, 10 individuals have pleaded guilty or been convicted for their involvement in the scheme. DOJ

Tagged in: Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

May 14, 2015

Westchester County Health Care Corporation (d/b/a Westchester Medical Center) agreed to pay $18.8 million to settle charges it violated the False Claims Act, the Anti-Kickback Statute and the Stark Law. According to the government, from approximately 2000 through 2007, WMC maintained a financial relationship with Cardiology Consultants of Westchester, P.C., a cardiology practice formerly operating on WMC’s Valhalla campus. WMC allegedly advanced monies to CCW to open a practice for the express purpose of generating referrals to the hospital. When CCW began making payments to WMC purportedly repaying the advances, WMC entered into retroactive, no-work consulting agreements under which it paid CCW tens of thousands of dollars. WMC also allegedly allowed CCW to use WMC’s fellows in CCW’s private office free of charge, contrary to WMC’s historic practice. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Provider Fraud,

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