Hospital Fraud Archives - Page 13 of 17

October 14, 2015

Santiago Borges, Erik Alonso and Cristina Alonso, all of Miami, pleaded guilty to federal healthcare fraud charges. Borges owned the now-defunct mental health centers R&S Community Mental Health Inc. and St. Theresa Community Mental Health Center Inc., and was an investor in New Day Community Mental Health Center LLC . Erik Alonso was the clinical director of all three centers. Cristina Alonso was a therapist at R&S. They admitted the clinics billed Medicare for costly partial hospitalization program services that were not medically necessary or not provided to patients. Borges also admitted he paid kickbacks to patient recruiters who, in exchange, referred beneficiaries to the centers. DOJ

Tagged in: Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Provider Fraud, Upcoding,

October 9, 2015

Cincinnati-based West Chester Hospital and its parent company, UC Health, agreed to pay $4.1 million to settle allegations that West Chester Hospital violated the False Claims Act by billing federal health care programs for medically unnecessary spine surgeries. The challenged surgeries were performed between 2009 and 2013 by Dr. Abubakar Atiq Durrani, a surgeon from Mason, Ohio, who had admitting privileges at West Chester Hospital and who was arrested in July 2013 but allegedly fled the country and remains a fugitive. The allegations first arose in a whistleblower lawsuit filed by former patients of Durrani under the qui tam provisions of the False Claims Act. They will receive a whistleblower award of approximately $800,000 from the federal share of the settlement. DOJ

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

September 29, 2015

Delaware-based St. Francis Hospital agreed to pay roughly $4 million to the US and $200,000 to the State of Delaware to resolve charges it violated the False Claims Act by improperly billing Medicare and Medicaid for patients admitted into its inpatient rehabilitation unit in Wilmington, Delaware between 2007 and 2010, when admission was not medically necessary and/or the services provided did not fully qualify for reimbursement. The settlement agreement also resolves separate allegations that St. Francis employed an individual who was excluded from participating in any Federal health care programs. DOJ (DE)

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

September 21, 2015

Non-profit healthcare organization Adventist Health System agreed to pay $115 million to settle allegations it violated the False Claims Act by maintaining improper compensation arrangements with referring physicians and by miscoding claims. The allegations originated in two whistleblower lawsuits filed by former Adventist hospital employees Michael Payne, Melissa Church and Gloria Pryor under the qui tam provisions of the False Claims Act. The will receive a yet-to-be-determined whistleblower award from the government’s recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Medical Billing Fraud, Multiple Whistleblowers and First-to-File, Whistleblower Case, Whistleblower Rewards,

September 15, 2015

North Broward Hospital District, operator of hospitals and other health care facilities in the Broward County, Florida area, agreed to pay $69.5 million to settle allegations it violated the False Claims Act by engaging in improper financial relationships with referring physicians. According to the government, the hospital district provided compensation to nine employed physicians that exceeded the fair market value of their services violating both the Stark Statute and False Claims Act. The allegations first arose from a whistleblower lawsuit filed by Dr. Michael Reilly under the qui tam provisions of the False Claims Act. Dr. Reilly will receive a whistleblower award of roughly $12 million. DOJ

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

September 4, 2015

Columbus Regional Healthcare System and Dr. Andrew Pippas agreed to pay more than $25 million to resolve allegations they violated the False Claims Act by submitting claims in violation of the Stark Law. The settlement also resolves allegations that Columbus Regional and Pippas submitted claims for payment to federal health care programs that misrepresented the level of services they provided. According to the government, between 2003 and 2013, Columbus Regional provided excessive salary and directorship payments to Pippas that violated the Stark Law. The government further alleged Columbus Regional submitted claims to federal health care programs for services at higher levels than supported by the documentation. The allegations first arose in two whistleblower lawsuits filed former Columbus Regional executive Richard Barker under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act. Barker will receive a yet-to-be-determined whistleblower award. DOJ

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

August 13, 2015

Two Southwest Missouri health care providers agreed to pay $5.5 million to settle allegations they violated the False Claims Act by engaging in improper financial relationships with referring physicians. The two providers are Mercy Health Springfield Communities (formerly known as St. John’s Health System Inc.) and its affiliate, Mercy Clinic Springfield Communities (formerly known as St. John’s Clinic). Specifically, the government charged the hospitals with submitting false claims to Medicare for services rendered to patients referred by physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals of patients to the clinic. The allegations first arose in a whistleblower lawsuit filed by Dr. Jean Moore, a physician who is employed by one of the defendants, under the qui tam provisions of the False Claims Act. Dr. Moore will receive a whistleblower award of $825,000. DOJ

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

August 12, 2015

Oswego Hospital will pay $1,456,457.33 to resolve False Claims Act charges stemming from healthcare billing improprieties the hospital self disclosed to the federal government. Dr. Vilas Patil, a physician formerly working as an independent contractor with Oswego, paid $204,365.97 to resolve False Claims Act liability in connection with a related investigation. Specifically, Oswego identified claims that were paid by federal and state payors where the supporting medical record documentation: (1) was not created or could not be located; (2) contained incorrect service dates; (3) were simply verbatim treatment notes from prior appointments with patients; and/or (4) failed to include time-related information required for certain time-based billing codes. DOJ

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud,

June 30, 2015

Community Health Network agreed to pay $20,324,902.22 to resolve allegations it violated the False Claims Act by submitting false claims to the Medicare and Medicaid programs. According to the government, since the late 1990s through October 2009, CHN had contracts with free-standing ambulatory surgery centers under which they would provide out-patient surgical services to CHN patients. CHN would then bill Medicare and Medicaid for the surgical services through the billing departments of its hospitals so it could improperly receive higher reimbursement rates. DOJ

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud,

June 29, 2015

John Muir Health agreed to pay $550,000 to resolve allegations it submitted false claims for Medicare reimbursement by failing to have physicians adequately supervise the delivery of radiation therapy services. The allegations originated in a whistleblower lawsuit filed by a former John Muir Health employee under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of $110,000 as her share of the government’s recovery. DOJ

Tagged in: FCA Federal, Hospital Fraud, Improper Medical Personnel, Whistleblower Case, Whistleblower Rewards,

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