Hospital Fraud

May 10, 2018

Cincinnati-based non-profit Mercy Health, which operates healthcare facilities in Ohio and Kentucky, agreed to pay $14,250,000 to settle allegations that it violated the False Claims Act and Stark Law by engaging in improper financial relationships with referring physicians. Specifically, the government alleged that Mercy Health provided compensation to six employed physicians that exceeded the fair market value of their services. DOJ

April 12, 2018

Arizona-based Banner Health agreed to pay over $18 million to settle claims that 12 of its hospitals in Arizona and Colorado submitted false claims to Medicare by admitting patients 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 former Banner employee Cecilia Guardiola. She will receive a whistleblower award of roughly $3.3 million from the proceeds of the government’s recovery. DOJ

March 27, 2018

Iowa acute care hospital Genesis Medical Center agreed to pay $1.88 million to settle claims it violated the False Claims Act by improperly retaining Medicare overpayments for hospital inpatient admission claims when those claims should have been billed at the lower reimbursement rate for either outpatient or observation services. DOJ (SDIA)

March 16, 2018

Four Maryland healthcare providers settled claims they violated the False Claims Act by improperly coding for certain medical tests they billed to Medicare: St. Agnes Healthcare, Inc., which owns and operates St Agnes hospital in Baltimore, agreed to pay roughly $70,000; Horizon Vascular Specialists agreed to pay roughly $518,000; Riverside Medical Associates agreed to pay roughly $177,000; and Maryland Specialty Group agreed to pay roughly $87,000.  Dr. Itsuro Uchino agreed to pay roughly $91,000. DOJ (MD)

March 7, 2018

UPMC Hamot, affiliated with the University of Pittsburgh Medical Center, and Medicor Associates Inc., a regional physician cardiology practice, agreed to pay $20.7 million to settle charges of violating the False Claims Act, Anti‑Kickback Statute and Stark Law through Hamot's payment under twelve physician and administrative services arrangements to secure Medicor patient referrals. Hamot allegedly had no legitimate need for the services contracted for, and in some instances the services either were duplicative or were not performed. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Medicor employee Dr. Tullio Emanuele. He will receive a whistleblower award of roughly $6 million from the proceeds of the government's recovery. DOJ

February 26, 2018

Brattleboro Memorial Hospital, Inc. paid $1,655,000 to settle claims it violated the False Claims Act by submitting outpatient laboratory claims lacking documentation necessary to support reimbursement by Medicare and Medicaid. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Amy Beth Main. She will receive a whistleblower award from the proceeds of the government’s recovery. DOJ (VT)

December 19, 2017

Two physician groups, EmCare Inc. and Physician’s Alliance Ltd, agreed to pay more than $33 million to settle charges of violating the False Claims Act and Anti-Kickback Statute for allegedly receiving kickbacks in exchange for patient referrals to hospitals owned by the now-defunct Health Management Associates. Dallas-based EmCare agreed to pay $29.6 million to resolve allegations it received remuneration from HMA to recommend patients be admitted to HMA hospitals on an inpatient basis when the patients should have been treated on an outpatient basis. In a separate settlement, Pennsylvania-based Physician's Alliance agreed to pay $4 million for allegedly accepting illegal remuneration from HMA to refer patients to two HMA hospitals, Lancaster Regional Medical Center and Heart of Lancaster Medical Center. The allegations originated in whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Drs. Thomas Mason and Stephen Folstad brought the qui tam suit against EmCare and will receive a whistleblower award of roughly $6.2 million from the proceeds of the government's recovery. Former HMA hospital executives George E. Miller and Michael J. Metts brought the qui tam suit against Physician's Alliance and will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ