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May 31, 2019

A Kansas hospital accused of submitting false claims to Medicare and Medicaid has agreed to pay $250,000 to settle a qui tam suit by Bashar Awad and Cynthia McKerrigan, with about $50,000 of the recovery going to the whistleblowers.  According to the suit, from 2012 to 2013, Coffey Health System falsely attested to having conducted or reviewed security risk analyses of electronic health records (EHR), which was a requirement under a federal incentive program that pays healthcare providers for adopting certified EHR technology.  USAO KS

May 31, 2019

Oklahoma Heart Hospital, LLC and Oklahoma Heart Hospital South, LLC (collectively “OHH”), have agreed to pay $2.8 million to resolve a qui tam suit by a former employee, which alleged that OHH violated the federal and state False Claims Acts and defrauded Medicaid by submitting claims for outpatient procedures as if they were inpatient procedures.  Though multiple allegations were raised in the lawsuit, only the allegation involving the upcoded claims was intervened by the government; the other allegations will be dismissed as part of the settlement.  USAO WDOK

April 30, 2019

The former CEO of hospital chain Health Management Associates LLC, Gary D. Newsome, has agreed to pay $3.46 million to resolve claims in a whistleblower lawsuit that he personally caused HMA to submit false claims to federal healthcare programs in violation of the False Claims Act.  Newsome was alleged to have caused HMA to pressure emergency department physicians to increase inpatient admissions without regard to medical necessity, so that the hospital chain could bill for more costly inpatient services.  In addition, Newsome was alleged to have caused HMA to make bonus payments to emergency department physicians, and contract concessions to the company, EmCare, that provided emergency department physician staffing, to increase inpatient admissions.  Newsome was the CEO from 2008 through 2013, prior to HMA's acquisition by Community Health Systems Inc.  HMA settled related claims in September 2018, and EmCare settled related claims in December 2017.  Two whistleblowers, Jacqueline Meyer, a former employee of EmCare, and J. Michael Cowling, a former employee of HMA, will receive approximately $725,000 from this settlement.  DOJ

April 29, 2019

In Washington State, St. Joseph Medical Center of Tacoma, along with seven other hospitals of its parent company CHI Franciscan, have agreed to provide $22 million in debt forgiveness and refunds to patients who qualified for charity care but did not receive it, despite requirements that hospitals screen patients for charity care eligibility and provide notice of the availability of charity care.  WA AG

February 14, 2019

Prime Healthcare Services and its CEO Prem Reddy, will pay $1.25 million to settle claims under the False Claims Act that two Prime Healthcare hospitals in Pennsylvania, Roxborough Memorial Hospital and Lower Bucks Hospital, billed Medicare for patients who were admitted when they could have been treated on an outpatient basis, and up-coded patient diagnoses to increase Medicare payments.  The investigation was initiated by an anonymous whistleblower identified as a former employee of the Roxborough hospital.  USAO ED PA

February 6, 2019

Georgia-based Union General Hospital has agreed to pay $5 million to settle allegations that from 2012 to 2016, it billed Medicare for services stemming from improper financial relationships with physicians, in violation of the Stark Law and the False Claims Act. The misconduct was uncovered during an internal investigation sparked by a federal investigation into an unrelated matter; UGH then voluntarily self-disclosed details of the instant case to the U.S. Attorney's Office. USAO NDGA

January 28, 2019

Avanti Hospitals LLC and six of its owners will pay $8.1 million to settle claims that they violated the False Claims Act by submitting, or causing Avanti’s subsidiary, Memorial Hospital of Gardena, to submit false claims to the Medicare and Medicaid programs for medical services referred by a physician who received kickbacks and other improper payments from Gardena and other Avanti affiliates. The settlement partially resolves allegations originally brought in a whistleblower lawsuit filed by Dr. Joshua Luke, the former C.E.O. of Gardena Hospital. DOJ

December 21, 2018

The United States has partially intervened in a False Claims Act case initiated by a whistleblower against Wheeling Hospital Inc. along with Wheeling's management consultant R & V Associates Ltd., and Wheeling's CEO, Ronald Violi.  The defendants are alleged to have violated the Stark Law and Anti-Kickback Statute including through its payments to physicians based on referrals by those physicians and/or in excess of fair market value.  The whistleblower, Louis Longo, was previously Wheeling's executive vice president.  DOJ

December 18, 2018

Following an earlier settlement of federal claims, Florida has announced that hospital chain Health Management Associates, LLC, will pay $5.5 million to Florida to resolve claims that two HMA hospitals, Charlotte Regional Medical Center and Peace River Medical Center, billed the Florida Medicaid program for services referred by physicians to whom HMA provided remuneration in return for patient referrals.  The unlawful remuneration took the form of free rent, office space, and staff services, as well as direct payments purportedly meant to cover overhead and administrative costs.  FL AG

October 9, 2018

The former CFO and COO of Houston-area Atrium Medical Center and Pristine Healthcare, Starsky Bomer, has been convicted for his role in a $16 million Medicare kickback scheme.  Bomer and others paid illegal kickbacks to group home owners and patient recruiters in exchange for the referral of Medicare patients for outpatient mental health treatment through the hospitals' partial hospitalization program (PHP).  While the hospitals billed Medicare $16 million for these patients, the evidence at trial demonstrated that Bomer knew that PHP services were not necessary for most of the patients, and that the patients were not, in fact, provided with such services.   DOJ
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