Hospital Fraud

March 31, 2015

Ohio-based Robinson Health System Inc. agreed to pay $10 million to settle claims it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute by engaging in improper financial relationships with referring physicians.  DOJ

March 23, 2015

Michigan-based Portage Hospital, LLC agreed to pay $4,446,392 to settle allegations its hospital-owned home health care agency, Portage Health Home Care & Hospice, violated the False Claims Act by submitting false claims to Medicare for unnecessary or unwarranted physical therapy services.  DOJ

February 24, 2015

Acadiana Cardiology LLC, Acadiana Cardiovascular Center and convicted doctor Mehmood Patel agreed to pay $650,000 to settle charges they violated the False Claims Act through unnecessary cardiovascular, endovascular and related procedures that Patel performed at Our Lady of Lourdes Hospital, Lafayette General Medical Center, Acadiana Cardiology and Acadiana Cardiovascular Center.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Christopher Mallavarapu, a cardiologist who formerly practiced with Patel.  DOJ

February 5, 2015

Minnesota-based medical device manufacturer ev3 Inc. (formerly known as Fox Hollow Technologies Inc.) agreed to pay $1.25M to resolve allegations it violated the False Claims Act by causing certain hospitals to submit false claims to Medicare for unnecessary inpatient admissions related to minimally-invasive atherectomy procedures for removing hardening of the arteries. According to the government, Fox Hollow sold the Silver Hawk Plaque Excision System for these procedures and advised hospitals to bill them as more expensive inpatient procedures, as opposed to less costly outpatient procedures, to artificially increase their Medicare reimbursement claims. The charges originated with a whistleblower lawsuit was filed under the qui tam provisions of the False Claims Act by former Fox Hollow sales representative Amanda Cashi. She will receive a whistleblower award of $250,000. DOJ

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