Hospital Fraud Archives - Page 7 of 17

Integra Med Analytics Files Whistleblower Lawsuit against Providence Health & Services and J.A. Thomas and Associates

Posted 08/30/18

London whistleblower attorney Mary Inman published in RAC Monitor (August 30, 2018). Click here to read the article.

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Eligibility,

August 15, 2018

Post Acute Medical, LLC has agreed to pay $13,031,502 to the United States, $114,016 to Texas, and $22,482 to Louisiana to settle allegations brought on by whistleblower Douglas Johnson that it violated the Anti-Kickback Statute, Physician Self-Referral Law, and state and federal False Claims Acts. The operator of long-term care and rehabilitation hospitals nationwide was accused of cultivating "reciprocal referral relationships" with outside healthcare providers and then billing Medicare and Medicaid for services that arose from those relationships. For his role in exposing the alleged fraud, Johnson will receive a cut of the federal government's share totaling $2,345,670. DOJ

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

Catch of the Week -- Prime Healthcare

Posted 08/9/18

Prime Healthcare, a nationwide healthcare provider that operates 45 hospitals and employs over 40,000 people, has settled allegations under the False Claims Act that 14 of its California hospitals improperly billed Medicare for admitting patients who only required outpatient care, and billed Medicare for treating more severe diagnoses than patients actually had. The company will pay just under $62 million to settle...

Tagged in: Catch of the Week, Damages and Penalties, Defendants, FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

August 3, 2018

Prime Healthcare Services and related entities, as well as its CEO Dr. Prem Reddy, will pay $65 million to settle two Medicare fraud allegations. First, Prime and Dr. Reddy allegedly engaged in a centralized scheme to boost inpatient admissions of patients who had no medical need to be admitted. Second, they allegedly falsely upcoded patients’ diagnoses in order to increase reimbursements. Whistleblower Karin Berntsen, who initiated the lawsuit, will receive over $17 million of the settlement. DOJ; CDCA

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

Catch of the Week -- William Beaumont Hospital

Posted 08/3/18

This week’s Department of Justice “Catch of the Week” goes to William Beaumont Hospital, a regional hospital system based in the Detroit area. On Thursday, the company agreed to pay $84.5 million to resolve allegations under the False Claims Act of improper relationships with eight referring physicians, resulting in the submission of false claims to the Medicare, Medicaid and TRICARE programs. The settlement...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

August 2, 2018

William Beaumont Hospital will pay $82.74 million to the federal government and $1.76 million to the state of Michigan to settle allegations made by four separate whistleblowers that between 2004 and 2012 it paid doctors above fair market value and provided them with perks such as free or discounted office space in return for patient referrals. Beaumont also allegedly falsely claimed that a CT radiology center qualified as an outpatient department. Beaumont has now entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General. It is not yet determined how much money the four whistleblowers will receive. DOJ

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

July 9, 2018

NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) entered a $14.7 million settlement with DOJ and a $895,427 settlement with New York based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid. Specifically, the defendants billed Medicare for undocumented E&M services, billed for home-health services without supporting medical records, and billed for orthopedic surgeons who referred patients in violation of the Physician Self-Referral Law, also known as the Stark Law. Three former Health Quest employees, who filed suit under the qui tam provisions of the False Claims Act, will receive a share of the recovery, including a reward of nearly $2 million to one of the relators. DOJ; USAO NDNY

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

Catch of the Week -- Health Quest Systems and Putnam Hospital Center

Posted 07/13/18

This week, DOJ announced a $14.7 million settlement with NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid, making Health Quest and Putnam our Catch of the Week. The settlement resolves allegations stemming from three separate lawsuits bought by...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Healthcare Fraud, Home Health and Hospice, Hospital Fraud, Medicaid, Medical Billing Fraud, Medicare, Multiple Whistleblowers and First-to-File, Upcoding, Whistleblower Case, Whistleblower Rewards,

June 21, 2018

Livingston Regional Hospital, a healthcare provider outside of Nashville, has paid $784K to settle FCA allegations that it improperly billed Medicare Part A for inpatient psychiatric care that was not medically necessary. The allegations were first brought forward by two whistleblowers who will receive a $156K reward. USAO Middle District of Tennessee

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

May 14, 2018

Houston-based healthcare provider Memorial Hermann Health System agreed to pay nearly $2 million to resolve allegations it admitted Medicare patients for surgical procedures to three company-owned hospitals, then fraudulently billed for the services provided to these patients at inpatient rates when it should have billed at lower outpatient rates. USAO SDTX

Tagged in: Hospital Fraud, Medical Billing Fraud, Upcoding,

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