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Hospital Fraud

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February 2, 2015

Tennessee-based Community Health Systems Professional Services Corporation and three affiliated New Mexico hospitals agreed to pay $75M to settle allegations they violated the False Claims Act by making illegal donations to county governments which were used to fund the state share of Medicaid payments to the hospitals. The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Community Health revenue manager Robert Baker. He will receive a whistleblower reward of $18,671,561 as his share of the government’s recovery. DOJ

October 30, 2014

San Francisco based hospital system Dignity Health (formerly known as Catholic Healthcare West) agreed to pay $37M to settle False Claim Act charges that 13 of its hospitals in California, Nevada and Arizona submitted false claims to Medicare and TRICARE by admitting patients for inpatient services 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 Kathleen Hawkins, a former employee of Dignity. She will receive a whistleblower award of $6.25M. DOJ

October 21, 2014

Kentucky-based cardiologists Satyabrata Chatterjee and Ashwini Anand, who jointly owned cardiologist physician group Cumberland Clinic, agreed to pay $380,000 to resolve allegations they violated the False Claims Act by entering into sham management agreements with Saint Joseph Hospital in exchange for the referral of cardiology procedures and other healthcare services to Saint Joseph. The government alleged that St. Joseph Hospital entered into sham agreements with Chatterjee and Anand, under which the physicians were paid to provide management services but did not in fact do so and that in exchange Chatterjee and Anand agreed to enter into an exclusive agreement with Saint Joseph to refer Cumberland Clinic patients to the hospital for cardiology and other services in violation of the Stark Law and the Anti-Kickback Statute. The government previously entered into a $16.5M settlement with Saint Joseph for the allegedly sham management contracts for unnecessary and excessive cardiology procedures. The allegations originated from a whistleblower lawsuit filed by three Lexington, Kentucky cardiologists under the qui tam provisions of the False Claims Act. The three whistleblowers, Drs. Michael Jones, Paula Hollingsworth and Michael Rukavina, will collectively receive a whistleblower award of $68,400. DOJ

October 20, 2014

A federal jury in Houston convicted Earnest Gibson III, the president of Riverside General Hospital, his son, and two others for their participation in a $158M Medicare fraud scheme involving false claims for mental health treatment. Ten defendants have now been convicted in connection with the Riverside fraud scheme. DOJ

August 4, 2014

Community Health Systems (CHS), the nation’s largest operator of acute care hospitals, agreed to pay $98 million to resolve multiple whistleblower lawsuits alleging the company billed government health care programs for inpatient services that should have been billed as outpatient or observation services. According to the government, CHS engaged in a corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and TRICARE (military) beneficiaries over the age of 65 who originally presented to the emergency departments at 119 CHS hospitals.Whistleblower Insider

July 21, 2014

Alabama-based hospital system Infirmary Health System Inc., along with two affiliated clinics and Diagnostic Physicians Group, agreed to pay $24.5M to resolve government allegations they violated the False Claims Act, the Anti-Kickback Statute and the Stark Law by paying or receiving financial inducements for medical referrals covered by Medicare.Whistleblower Insider

May 28, 2014

Kentucky-based hospital King’s Daughters Medical Center agreed to pay $40.9M to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare and Kentucky Medicaid programs for medically unnecessary coronary stents and diagnostic catheterizations. The government also alleged that several King’s Daughters physicians falsified medical records to justify these unnecessary cardiac procedures. Whistleblower Insider

May 6, 2014

Baptist Health System, the parent company for a network of affiliated hospitals and medical providers in the Jacksonville, Florida area, agreed to pay $2.5M to settle allegations that its subsidiaries violated the False Claims Act by submitting claims to Medicare and Medicaid for medically unnecessary services and drugs. Specifically, the government charged that two neurologists in the Baptist Health network intentionally misdiagnosed patients with various neurological disorders so they could bill the government health care programs for services and drugs they did not actually need. The allegations were first raised in a qui tam lawsuit filed by former Baptist Health employee, Verchetta Wells, under the whistleblower provisions of the False Claims Act. DOJ

March 13, 2014

Memorial Hospital, the operator of an acute care hospital facility in Ohio, agreed to pay $8.5M to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute by engaging in improper financial relationships with referring physicians. DOJ

January 29, 2014

Saint Joseph Health System agreed to pay $16.5 million to resolve allegations that Saint Joseph Hospital violated the False Claims Act by submitting false claims to the Medicare and Kentucky Medicaid programs for a variety of medically unnecessary cardiac procedures. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ
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