Archive

April 12, 2018

Arizona-based Banner Health agreed to pay over $18 million to settle claims that 12 of its hospitals in Arizona and Colorado submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Banner employee Cecilia Guardiola. She will receive a whistleblower award of roughly $3.3 million from the proceeds of the government’s recovery. DOJ

March 27, 2018

Iowa acute care hospital Genesis Medical Center agreed to pay $1.88 million to settle claims it violated the False Claims Act by improperly retaining Medicare overpayments for hospital inpatient admission claims when those claims should have been billed at the lower reimbursement rate for either outpatient or observation services. DOJ (SDIA)

March 16, 2018

Four Maryland healthcare providers settled claims they violated the False Claims Act by improperly coding for certain medical tests they billed to Medicare: St. Agnes Healthcare, Inc., which owns and operates St Agnes hospital in Baltimore, agreed to pay roughly $70,000; Horizon Vascular Specialists agreed to pay roughly $518,000; Riverside Medical Associates agreed to pay roughly $177,000; and Maryland Specialty Group agreed to pay roughly $87,000.  Dr. Itsuro Uchino agreed to pay roughly $91,000. DOJ (MD)

March 7, 2018

UPMC Hamot, affiliated with the University of Pittsburgh Medical Center, and Medicor Associates Inc., a regional physician cardiology practice, agreed to pay $20.7 million to settle charges of violating the False Claims Act, Anti‑Kickback Statute and Stark Law through Hamot's payment under twelve physician and administrative services arrangements to secure Medicor patient referrals. Hamot allegedly had no legitimate need for the services contracted for, and in some instances the services either were duplicative or were not performed. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Medicor employee Dr. Tullio Emanuele. He will receive a whistleblower award of roughly $6 million from the proceeds of the government's recovery. DOJ

February 26, 2018

Brattleboro Memorial Hospital, Inc. paid $1,655,000 to settle claims it violated the False Claims Act by submitting outpatient laboratory claims lacking documentation necessary to support reimbursement by Medicare and Medicaid. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Amy Beth Main. She will receive a whistleblower award from the proceeds of the government’s recovery. DOJ (VT)

December 19, 2017

Two physician groups, EmCare Inc. and Physician’s Alliance Ltd, agreed to pay more than $33 million to settle charges of violating the False Claims Act and Anti-Kickback Statute for allegedly receiving kickbacks in exchange for patient referrals to hospitals owned by the now-defunct Health Management Associates. Dallas-based EmCare agreed to pay $29.6 million to resolve allegations it received remuneration from HMA to recommend patients be admitted to HMA hospitals on an inpatient basis when the patients should have been treated on an outpatient basis. In a separate settlement, Pennsylvania-based Physician's Alliance agreed to pay $4 million for allegedly accepting illegal remuneration from HMA to refer patients to two HMA hospitals, Lancaster Regional Medical Center and Heart of Lancaster Medical Center. The allegations originated in whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Drs. Thomas Mason and Stephen Folstad brought the qui tam suit against EmCare and will receive a whistleblower award of roughly $6.2 million from the proceeds of the government's recovery. Former HMA hospital executives George E. Miller and Michael J. Metts brought the qui tam suit against Physician's Alliance and will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ

December 1, 2017

Pine Creek Medical Center LLC, a physician-owned hospital serving the Dallas/Fort Worth area, agreed to pay $7.5 million to resolve claims it violated the False Claims Act and Anti-Kickback Statute by paying physicians kickbacks in the form of marketing services in exchange for surgical referrals.  Specifically, Pine Creek allegedly paid for advertisements on behalf of the physicians as well as radio and television advertising, pay-per-click advertising campaigns, billboards, website upgrades, brochures, and business cards, and other forms of marketing to induce physicians to refer patients to Pine Creek for medical services.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by former Pine Creek employees Suzanne Scott and Savannah Sogar.  They will receive a whistleblower award of $1,125,000 from the proceeds of the government's recovery.  DOJ

November 17, 2017

Meadows Regional Medical Center, Inc. agreed to pay up to $12,875,000 to resolve allegations of violating the False Claims Act, Anti-Kickback Statute and Stark Law by submitting claims referred by physicians with whom Meadows had improper compensation arrangements.  DOJ (SDGA)

October 4, 2017

Four Houston-area hospitals agreed to pay $8.6 million to settle allegations they violated the False Claims Act and Anti-Kickback Statute by receiving kickbacks from various ambulance companies in exchange for rights to the hospitals’ more lucrative Medicare and Medicaid transport referrals.  The hospitals are all affiliated with Nashville-based Hospital Corporation of America include Bayshore Medical Center, Clear Lake Regional Medical Center, West Houston Medical Center and East Houston Regional Medical Center.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive an award from the proceeds of the government's recovery. DOJ (SDTX)

September 27, 2017

South Carolina hospital AnMed Health agreed to pay over $7 million to resolve allegations it violated the False Claims Act by knowingly disregarding the statutory conditions for submitting claims to the Medicare program for a variety of services, including radiation oncology services, emergency department services, and clinic services.  Specifically, the government alleged that AnMed Health billed for radiation oncology services for Medicare patients when a qualified practitioner was not immediately available to provide assistance and direction throughout the radiation procedure, as required by Medicare regulations.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former AnMed Health employee Linda Jainniney.  She will receive a whistleblower award of roughly $1.2 million from the proceeds of the government's recovery.  DOJ (NDGA)