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DOJ Catch of the Week -- Community Health Systems

Posted  August 8, 2014

By the C|C Whistleblower Lawyer Team

This week’s Department of Justice “catch of the week” goes to Community Health Systems, Inc.  On Monday, the Tennessee-based operator of acute care hospitals — the largest in the country with 206 affiliated hospitals in 29 states — agreed to pay $98 million to resolve charges of billing the government for inpatient services that should have been billed as significantly less expensive outpatient or observation services.  See DOJ press release.

Specifically, the government claimed Community Health engaged in a corporate-driven scheme to increase inpatient admissions from emergency room visits of Medicare, Medicaid and TRICARE (military) beneficiaries over the age of 65.  According to the government, Community Health at more than one-hundred of its hospitals routinely admitted these individuals for inpatient services that were not medically necessary and when less costly outpatient or observations services would have sufficed. The government further alleged that one particular hospital billed Medicare for inpatient cardiac and hemodialysis procedures that should have been performed on a lower cost outpatient basis.  That hospital also allegedly violated the Physician Self-Referral Law, commonly known as the Stark Law, by billing for services provided by a physician with whom the hospital had an improper financial relationship.

The settlement resolves lawsuits filed by several whistleblowers under the qui tam provisions of the False Claims Act.  The whistleblowers are all former employees of various Community Health System hospitals across the country.  They include Kathleen Bryant, former Director of Health Information Management at Heritage Medical Center (Tennessee); Rachel Bryant, former nurse at Dyersburg Hospital (Tennessee); Bryan Carnithan, former Emergency Medical Services Coordinator at Heartland Hospital (Illinois); Amy Cook-Reska, former coder for Laredo Medical Center (Texas); Sheree Cook, former nurse at Heritage Medical Center; James Doghramji, former internal medicine and emergency room physician at Chestnut Hill Hospital (Pennsylvania); Thomas Mason, former emergency room physician at Lake Norman Regional Medical Center (North Carolina); Scott Plantz, former emergency room physician at Longview Regional Medical Center (Texas); and Nancy Reuille, former nurse and Supervisor of Case Management at Lutheran Hospital (Indiana).  The whistleblowers’ share of the settlement has not yet been determined.

Tagged in: Anti-Kickback and Stark, Catch of the Week, Other Government Health Programs,