Archive

September 28, 2018

Kalispell Regional Healthcare System and six of its related entities agreed to pay $24 million to settle a False Claims Act case based on its compensation arrangements with physicians, which were alleged to violate the Stark Law, and other arrangements alleged to violate the Anti-Kickback Statute. Between 2010 and 2018, KRH entities reportedly paid excessive and above-market full-time compensation to more than 60 physicians, even if those physicians worked far less than full-time. In addition, some of the KRH entities were alleged to unlawfully seek referrals from physicians through excessive compensation arrangements and the provision of administrative services at below market rates. Jon Mohatt, the former CFO of a related entity, initiated the action with a qui tam filing; Mohatt will receive $5.4 million dollars as a relator's share of the government's recovery. DOJ

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

September 26, 2018

Health Management Associates, LLC (HMA)—now part of Community Health Systems Inc. (CHS)—has agreed to pay a combined $260 million to settle civil and criminal charges of defrauding Medicare, Medicaid, and TRICARE and violating the Anti-Kickback Statute, the Stark Law, and False Claims Act. The alleged fraud was revealed by eight whistleblowers and involved paying kickbacks to doctors for patient referrals, pressuring doctors to meet emergency patient admission quotas, billing outpatient or observational services as inpatient services, and inflating the cost of emergency services. The eight whistleblowers have been granted a combined $27 million award so far. DOJ; USAO EDPA; USAO SDFL; USAO WDNC

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Other Government Health Programs, Whistleblower Rewards,

September 25, 2018

Virginia Commonwealth University Health System Authority, which operates a hospital and related facilities in Richmond, Virginia, agreed to pay $4 million to resolve claims that it overbilled government healthcare programs for radiation oncology services from 2009 through 2014. The settlement follows VCU's voluntary disclosure of the overbilling after an audit of patient files and billing data. E.D. Va. USAO

Tagged in: Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Provider Fraud,

August 15, 2018

Post Acute Medical, LLC has agreed to pay $13,031,502 to the United States, $114,016 to Texas, and $22,482 to Louisiana to settle allegations brought on by whistleblower Douglas Johnson that it violated the Anti-Kickback Statute, Physician Self-Referral Law, and state and federal False Claims Acts. The operator of long-term care and rehabilitation hospitals nationwide was accused of cultivating "reciprocal referral relationships" with outside healthcare providers and then billing Medicare and Medicaid for services that arose from those relationships. For his role in exposing the alleged fraud, Johnson will receive a cut of the federal government's share totaling $2,345,670. DOJ

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

August 3, 2018

Prime Healthcare Services and related entities, as well as its CEO Dr. Prem Reddy, will pay $65 million to settle two Medicare fraud allegations. First, Prime and Dr. Reddy allegedly engaged in a centralized scheme to boost inpatient admissions of patients who had no medical need to be admitted. Second, they allegedly falsely upcoded patients’ diagnoses in order to increase reimbursements. Whistleblower Karin Berntsen, who initiated the lawsuit, will receive over $17 million of the settlement. DOJ; CDCA

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Upcoding, Whistleblower Case, Whistleblower Rewards,

August 2, 2018

William Beaumont Hospital will pay $82.74 million to the federal government and $1.76 million to the state of Michigan to settle allegations made by four separate whistleblowers that between 2004 and 2012 it paid doctors above fair market value and provided them with perks such as free or discounted office space in return for patient referrals. Beaumont also allegedly falsely claimed that a CT radiology center qualified as an outpatient department. Beaumont has now entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General. It is not yet determined how much money the four whistleblowers will receive. DOJ

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

July 9, 2018

NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) entered a $14.7 million settlement with DOJ and a $895,427 settlement with New York based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid. Specifically, the defendants billed Medicare for undocumented E&M services, billed for home-health services without supporting medical records, and billed for orthopedic surgeons who referred patients in violation of the Physician Self-Referral Law, also known as the Stark Law. Three former Health Quest employees, who filed suit under the qui tam provisions of the False Claims Act, will receive a share of the recovery, including a reward of nearly $2 million to one of the relators. DOJ; USAO NDNY

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

June 21, 2018

Livingston Regional Hospital, a healthcare provider outside of Nashville, has paid $784K to settle FCA allegations that it improperly billed Medicare Part A for inpatient psychiatric care that was not medically necessary. The allegations were first brought forward by two whistleblowers who will receive a $156K reward. USAO Middle District of Tennessee

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

May 14, 2018

Houston-based healthcare provider Memorial Hermann Health System agreed to pay nearly $2 million to resolve allegations it admitted Medicare patients for surgical procedures to three company-owned hospitals, then fraudulently billed for the services provided to these patients at inpatient rates when it should have billed at lower outpatient rates. USAO SDTX

Tagged in: Hospital Fraud, Medical Billing Fraud, Upcoding,

May 10, 2018

Cincinnati-based non-profit Mercy Health, which operates healthcare facilities in Ohio and Kentucky, agreed to pay $14,250,000 to settle allegations that it violated the False Claims Act and Stark Law by engaging in improper financial relationships with referring physicians. Specifically, the government alleged that Mercy Health provided compensation to six employed physicians that exceeded the fair market value of their services. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Hospital Fraud,

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