Hospital Fraud
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December 7, 2022
Dignity Health and the Tenet Healthcare hospitals Twin Cities Community Hospital and Sierra Vista Regional Medical Center will pay a total of $22.5 million to resolve allegations that they submitted false claims to Medi-Cal in connection with the ACA’s Medicaid Adult Expansion program. The defendants, who contracted with Medi-Cal, agreed to provide healthcare services to this newly-insured population and return surplus funds if they did not spend at least 85% of the specified funds on eligible services. The government alleged that the hospitals falsely billed for “Enhanced Services,” which allowed them to overstate AE spending, including by billing for services that were duplicative of services already required. The settlements resolve claims brought in a whistleblower action by Julio Bordas, who previously served as a Medical Director for CenCal Health, the County Organized Health System through which Medi-Cal contracted with the hospitals. Bordas will receive $3.9 million as his share of the federal recovery. DOJ; USAO CD Cal; CAJuly 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 NDWVAmerican hospitals have been resistant to whistleblowers. Here’s how they can save money and lives by embracing them.
Posted 06/21/22
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 MAApril 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 FLAs Whistleblowers and Quality Care Advocates, Hospitalists are the Conscience of Healthcare
Posted 02/28/22
Top 5 Reasons Why Nurses Make Great Whistleblowers
Posted 02/22/22
