Oklahoma Hospital To Pay $13 Million To Resolve False Claims Act Allegations
January 27, 2010 by nick
On December 22, 2009, the Department of Justice released the settlement of a False Claims Act case involving St. John Health System of Tulsa, Oklahoma. The health provider has agreed to pay the United States $13,229,348.88 to settle allegations that it submitted false claims to Medicare and Medicaid.
Specifically, the United States determined that St. John made payments to 23 individual physicians or physician groups to induce referrals for medical services. Federal law prohibits healthcare providers from billing federal health care programs for referrals from doctors with whom they have a financial relationship, unless that relationship falls within certain exceptions.
St. John’s fraudulent financial relationships were disclosed in a report filed by the health provider to the Department of Health and Human Service’s Office of Inspector General. The report suggested that the agreements with physicians may have violated federal law.
“The resolution of this matter yielded a substantial recovery for taxpayers, and it underscores our commitment to ensure that services reimbursable by federal health care programs are based on the best interests of patients rather than the personal financial interests of referring physicians,” said Tony West, Assistant Attorney General for the Department’s Civil Division.
If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
Three Health Agencies Sued For Using Unqualified ‘Home Health Aides’
December 24, 2009 by nick
On December 17, 2009, the office of the New York Attorney General announced a $24 million settlement to a False Claims Act lawsuit involving three home health agencies. The agencies utilized hundreds of “home health aides” with little or no required training. These aides were sent to the homes of New York’s elderly, frail and indigent to provide sensitive medical care they were not qualified to administer. As a result, Medicaid was billed millions of dollars for illegitimate services.
Under the terms of the settlement, B&H Health Care Services, Inc., known as Nursing Personnel Home Care, Excellent Home Care Services, LLC, and Extended Nursing Personnel CHHA, LLC, will return $23,963,100 to Medicaid–a program jointly funded by the state and federal governments. Of this amount, the State of New York will receive a total of $14,377,860.
The settlements were initiated by lawsuits filed under the whistleblower provisions of the False Claims Act, which allow private citizens to file suit on behalf of the United States for fraud and share in any recovery. Maurice Keshner will receive approximately $1,693,343 from New York’s recovery from Nursing Personnel. Deborah Yannicelli will receive approximately $994,080 from New York’s recovery from Extended and Excellent. The Act also provides protection against job retaliation for whistleblowing.
Medicaid requires home health aides – who primarily care for elderly patients, administer medication, and provide services such as catheter care, colostomy care and wound care – to successfully complete a training program licensed by the Department of Health or the State Education Department. All such aides must receive a minimum of 75 hours of training, including sixteen hours of supervised practical training conducted by a registered nurse.
If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
Pharmaceutical Company Will Pay $21 Million for Overpricing Respiratory Drugs
December 24, 2009 by nick
On December 17, 2009, Bloomberg News reported that Schering-Plough Corp., a drug company, will pay $21.3 million to settle a False Claims Act lawsuit against it. The settlement stems from a whistleblower lawsuit against several drug companies accused of Medicaid fraud.
The suit alleged that Schering deliberately inflated the average wholesale price it reported to California for Albuterol, a treatment for asthma and other breathing problems, as well as other drugs. As a result, California’s Medi-Cal program overpaid millions of dollars in pharmacy reimbursements.
Schlering was recently acquired by Merck & Co. of New Jersey. Merck didn’t admit wrongdoing and said its pricing practices complied with regulations and contracts. The settlement amount was reserved and significantly funded by Schering-Plough prior to its merger with Merck in November, Merck said.
If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
Three HealthEast Hospitals Will Pay $2.28 Million For Fraudulent Policy
June 4, 2009 by casey
On Thursday, May 21, the Department of Justice announced a $2.28 million settlement between three HealthEast Care System hospitals and the United States. It was alleged that the hospitals, all of which are located in the Minneapolis/St. Paul area of Minnesota, performed kyphoplasties on an inpatient basis in order to increase their Medicare billings.
Kyphoplasties, which are minimally-invasive procedures used to treat osteoporosis-evoked spinal fractures, are typically performed on an outpatient basis. “Outpatient” procedures do not require admission to a hospital and can even be performed outside hospital facilities. By performing kyphoplasties on an inpatient basis, patients were unnecessarily admitted to the hospital and closely monitored before, during, and after the procedure.
In this fashion, the hospitals overcharged Medicare thousands of dollars for each kyphoplasty they performed.
“By keeping patients overnight, hospitals could seek greater reimbursement from Medicare and make much larger profits on kyphoplasty,” said Kathleen Mehltretter, Acting U.S. Attorney for the Western District of New York in Buffalo.
The whistleblower suit was brought under the False Claims Act, which permits private citizens to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment awarded against a defendant. The lawsuit was filed in 2008 in federal district court in Buffalo, N.Y. by Craig Patrick and Charles Bates. Mr. Patrick of Hudson, Wis., is a former reimbursement manager for Kyphon, and Mr. Bates was formerly a regional sales manager for Kyphon in Birmingham, Ala.
If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
