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Hospital Fraud

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July 7, 2022

A hospital in West Virginia, Weirton Medical Center, has agreed to pay $1.5 million to settle allegations of submitting or causing to be submitted claims to Medicare that resulted from an improper financial relationship.  In violation of the Stark Law, Weirton allegedly paid referring physicians compensation based on volume and that exceeded fair market value.  USAO NDWV

American hospitals have been resistant to whistleblowers. Here’s how they can save money and lives by embracing them.

Posted  06/21/22
Hospital Building
Last month, the American Hospital Association wrote a pointed letter to the Justice Department, asking them to investigate, and potentially sue, Medicare Advantage plans for improperly denying coverage of patients’ hospital services. Medicare Advantage is a popular government program that pays private insurers premiums to cover seniors, and the insurers are required by law to provide at least the same benefits as...

June 10, 2022

Steward Health Care System LLC and related entities will pay $4.7 million to resolve allegations of False Claims Act violations involving improper financial and referral arrangements between SHC and physician practices. Steward Good Samaritan Medical Center, Inc., contracted with Brockton Urology Clinic to administer a Prostate Cancer Center of Excellence at SGSMC. SGSMC paid BUC throughout the agreement as compensation for sending referrals to SGSMC. The investigation revealed other such arrangements between Steward and physician practices. The conduct was exposed by whistleblowers, who filed under the FCA’s qui tam provisions. The relators will receive 17% of the recovery. USAO MA

April 6, 2022

Florida hospital chain BayCare Health System Inc. will pay $20 million to resolve claims that the company knowingly caused false claims for federal Medicaid matching funds to be submitted to the United States by making improper, non-bona fide cash donations to the Juvenile Welfare Board of Pinellas County (JWB) knowing that the funds would be transferred by JWB to the State of Florida’s Agency for Health Care Administration for Florida’s Medicaid Program, which would trigger a corresponding federal matching payment.  The prohibition on non-bona fide donations ensures that states are paying a share of Medicaid payments; the non-bona fide donations increased Medicaid payments received by BayCare without any actual expenditure of state or local funds and enabled BayCare to recoup its original donations to JWB and also receive federal matching funds. The case was initiated with a qui tam complaint filed by Larry Bomar, who will receive $5 million as an award for initiating the whistleblower action. DOJ; MD FL

As Whistleblowers and Quality Care Advocates, Hospitalists are the Conscience of Healthcare

Posted  02/28/22
By Mary Inman, Ari Yampolsky
Thursday, March 3, 2022 is National Hospitalist Day, a day we recognize the contributions of the specialist care doctors and other professionals who provide quality care to sick and vulnerable patients in a hospital.  As the fastest growing specialty in modern medicine, hospitalists are a critical part of the nation’s health care service delivery system. Less noted but no less important, hospitalists also play a...

Top 5 Reasons Why Nurses Make Great Whistleblowers

Posted  02/22/22
By Edward Baker
hospital staff
Nurses are rightly getting a lot of attention lately for the courageous and essential role they are playing on the front-line during the COVID-19 pandemic.  Whether in hospitals, nursing homes, hospices, or as home health workers, nurses are finally “learning what they are worth,” even as private equity firms seek to profit from nurses’ increased wage-earning power.  As reported by STAT, Congress is now...

February 9, 2022

The Catholic Medical Center (CMC) will pay $3.8 million for violations of the False Claims Act and the Anti-Kickback Statute. Over a ten-year period, the CMC provided call coverage services to a cardiologist, for free, in exchange for lucrative referrals to their hospital, resulting in receipt of millions of dollars for services and medical procedures. USAO NH

January 20, 2022

A three-year-long kickback scheme effectuated by a hospital executive and seven doctors will net the DOJ a $1.1 million settlement and their continued cooperation in the investigation of and litigation against other parties. The Stark Law and Anti-Kickback Statute violations occurred over a three-year period, wherein management service organizations (MSOs) paid volume-based commissions kickbacks for ordering laboratory tests from Rockdale Hospital d/b/a Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation. Jaspaul Bhangoo, M.D., Robert Megna, D.O., Baxter Montgomery, M.D., Murtaza Mussaji, D.O., David Sneed, D.O., Kevin Lewis, D.O., and Angela Mosley-Nunnery, M.D. will all contribute to the settlement. Additionally, Richard Defoore, former CEO of Jones County Regional Healthcare d/b/a Stamford Memorial Hospital, also agreed to pay into the settlement fund for his contribution to the scheme. USAO EDTX

Sutter Health – Medicare Advantage Fraud ($90 million)

Constantine Cannon represented whistleblower Kathy Ormsby in a False Claims Act litigation against Sutter Health and its affiliates that resulted in a $90 million settlement – the largest Medicare Advantage FCA settlement to date against a hospital system, and the second largest reported Medicare Advantage fraud settlement to date.  Ms. Ormsby, a former Risk Adjustment Factor Project Manager at Sutter Health affiliate Palo Alto Medical Foundation, alleged the Sutter Health defendants inflated the number and severity of Medicare Advantage patient diagnoses, manipulated patient records, ignored audit “red flags,” and engaged in other misconduct to increase patient risk scores and obtain Medicare Advantage payments to which they were not entitled.  In Spring 2019, the Government intervened in Ms. Ormsby’s case as to PAMF, and Ms. Ormsby continued to pursue her claims against the other Sutter Health affiliates on a non-intervened basis. This settlement resolves all claims and follows Sutter’s unsuccessful effort to dismiss both the complaints.  Read more: Press Release; Whistleblower Insider.

August 17, 2021

Following a voluntary self-disclosure to authorities, Blessing Hospital in Quincy, Illinois, has agreed to pay $2.82 million to resolve allegations that it submitted false claims for the facility component of medically unnecessary cardiac catheterization procedures.  The federal government will receive $2.6 million of the settlement, with the remainder going to Illinois, Iowa, and Missouri.  USAO CD IL
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