Hospital Fraud

December 1, 2017

Pine Creek Medical Center LLC, a physician-owned hospital serving the Dallas/Fort Worth area, agreed to pay $7.5 million to resolve claims it violated the False Claims Act and Anti-Kickback Statute by paying physicians kickbacks in the form of marketing services in exchange for surgical referrals.  Specifically, Pine Creek allegedly paid for advertisements on behalf of the physicians as well as radio and television advertising, pay-per-click advertising campaigns, billboards, website upgrades, brochures, and business cards, and other forms of marketing to induce physicians to refer patients to Pine Creek for medical services.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by former Pine Creek employees Suzanne Scott and Savannah Sogar.  They will receive a whistleblower award of $1,125,000 from the proceeds of the government's recovery.  DOJ

November 17, 2017

Meadows Regional Medical Center, Inc. agreed to pay up to $12,875,000 to resolve allegations of violating the False Claims Act, Anti-Kickback Statute and Stark Law by submitting claims referred by physicians with whom Meadows had improper compensation arrangements.  DOJ (SDGA)

October 4, 2017

Four Houston-area hospitals agreed to pay $8.6 million to settle allegations they violated the False Claims Act and Anti-Kickback Statute by receiving kickbacks from various ambulance companies in exchange for rights to the hospitals’ more lucrative Medicare and Medicaid transport referrals.  The hospitals are all affiliated with Nashville-based Hospital Corporation of America include Bayshore Medical Center, Clear Lake Regional Medical Center, West Houston Medical Center and East Houston Regional Medical Center.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive an award from the proceeds of the government's recovery. DOJ (SDTX)

September 27, 2017

South Carolina hospital AnMed Health agreed to pay over $7 million to resolve allegations it violated the False Claims Act by knowingly disregarding the statutory conditions for submitting claims to the Medicare program for a variety of services, including radiation oncology services, emergency department services, and clinic services.  Specifically, the government alleged that AnMed Health billed for radiation oncology services for Medicare patients when a qualified practitioner was not immediately available to provide assistance and direction throughout the radiation procedure, as required by Medicare regulations.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former AnMed Health employee Linda Jainniney.  She will receive a whistleblower award of roughly $1.2 million from the proceeds of the government's recovery.  DOJ (NDGA)

September 13, 2017

MediSys Health Network Inc., which owns and operates the two Queens hospitals Jamaica Hospital Medical Center and Flushing Hospital and Medical Center agreed to pay $4 million to settle allegations that it violated the False Claims Act by engaging in improper financial relationships with referring physicians.  These relationships took the form of compensation and office lease arrangements that did not comply with the requirements of the Stark Law, which restricts the financial relationships that hospitals may have with doctors who refer patients to them.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Satish Deshpande.  Dr. Deshpande will receive a whistleblower award of $600,000 from the proceeds of the government's recovery. DOJ

September 1, 2017

New Mexico-based Christus St. Vincent Regional Medical Center and its partner Texas-based Christus Health agreed to pay $12.24 million to resolve 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 hospital.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Los Alamos County, New Mexico Indigent Healthcare Administrator.  The whistleblower will receive an award of $2.25 million from the proceeds of the government's recovery. DOJ

August 23, 2017

St. Agnes Healthcare agreed to pay roughly $123,000 to settle charges of violating the False Claims Act by billing Medicare for evaluation and management services at a higher reimbursement rate than the Federal health care programs allowed.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Jonathan Safren, a former St. Agnes cardiologist.  He will receive a whistleblower award of $20,000 from the proceeds of the government's recovery. DOJ (DMD)