Hospital Fraud
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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. DOJMarch 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. DOJJanuary 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. DOJDecember 31, 2013
St. James Healthcare and its parent company, Sisters of Charity of Leavenworth Health System, agreed to pay $3.85M to resolve allegations that they violated the Anti-Kickback Statute, the Stark Law and the False Claims Act by improperly providing financial benefits to physicians and physician groups that made referrals to the hospital. DOJDecember 18, 2015
Constantine Cannon partner Tim McCormack was quoted in the Modern Healthcare article, 32 hospitals will pay $28 million to resolve kyphoplasty probe. Click here to read the article.December 18, 2015
Thirty-two hospitals in 15 states agreed to pay more than $28 million to settle charges they violated the False Claims Act by submitting false claims to Medicare for minimally-invasive kyphoplasty procedures used to treat certain spinal fractures often arising from osteoporosis. According to the government, the settling hospitals billed Medicare for these procedures on a more costly inpatient basis when they should have been billed on a less costly outpatient basis. The government has now reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations of overcharging Medicare for kyphoplasty procedures. The 15 current settling hospitals include: The Cleveland Clinic (Ohio); Citrus Memorial Health System (Florida); Cullman Regional Medical Center (Alabama); Martin Memorial Medical Center (Florida); MultiCare Tacoma General Hospital (Washington); Norwalk Hospital (Connecticut); Princeton Community Hospital Association (West Virginia); Sacred Heart Medical Center (Washington); Sarasota Memorial Hospital (Florida); Spartanburg Regional Health Services District Inc. (South Carolina); St. Cloud Hospital (Minnesota); Tampa General Hospital (Florida); 5 hospitals affiliated with Community Health Systems Inc. (Tennessee); 5 hospitals affiliated with Tenet Health Care Corporation (Texas); 5 hospitals formerly owned and operated by Health Management Associates (Florida); 3 hospitals affiliated with BayCare Health System (Florida); and 2 hospitals affiliated with Banner Health (Arizona). In addition, the government previously settled with Medtronic Spine LLC, the corporate successor to Kyphon Inc., for $75 million to settle allegations the company caused false claims to be submitted to Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures. All but 3 of the current settlements originated in a whistleblower lawsuit filed by Craig Patrick, a former Kyphon reimbursement manager, and Charles Bates, a former Kyphon sales manager for Kyphon. They will receive a whistleblower award of roughly $4.75 million from the proceeds of the government’s recovery. DOJNovember 21, 2015
Constantine Cannon partner Tim McCormack was quoted in the Modern Healthcare article, Whistle-blower worries: Hospitals likely to see more False Claims suits tied to doctor compensation. Click here to read the article.DOJ’s Adventist Settlement Puts the Power of Whistleblowers in “Stark” Relief
Posted 09/23/15
By Tim McCormack and Molly Knobler (published on SCCE’s Compliance and Ethics Blog)
There is no denying that certain aspects of the Physician Self-Referral Law, more commonly known as the “Stark Law,” are complicated. The Stark Law and its corresponding regulatory scheme include a web of technical terms, safe harbors, and interpretive guidance. Is this complexity a necessary byproduct of the...
Barker Decision Extends Attorney-Client Privilege Waiver to False Claims Act Cases
Posted 09/4/14
The attorney-client privilege is perhaps the most critical component of the attorney-client relationship. As the Supreme Court declared in its landmark Upjohn decision, the privilege exists "to encourage full and frank communication between attorneys and their clients and thereby promote broader public interests in the observation of law and administration of justice." As most would agree, without the privilege...