HOSPITALS AND HEALTH SYSTEMS
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
Hospital system, its physician CEO and a physician agreed to pay $37.5 million to resolve federal and state FCA allegations that: (1) Prime paid above FMV to purchase the physician’s practice to induce referrals to the hospital, then compensated the physician through an employment agreement that was improperly based on the volume and value of his referrals, in violation of the AKS; (2) a hospital and the physician used the physician’s billing number to submit claims to Medicare and Medi-Cal for services that were actually provided by a physician whose billing privileges they knew had been revoked; and (3) hospitals submitted inflated invoices for implantable medical hardware to Medi-Cal and other government payors. 7 The settlement resolves allegations raised in two qui tam lawsuits in which the government declined to intervene. Prime agreed to pay $33.725 million, with the CEO and physician agreeing to pay $1.775 million and $2 million, respectively. As part of the settlement, Prime and its CEO entered into a five-year CIA with HHS-OIG. Hospital agreed to pay more than $560,000 to resolve allegations related to an employed physician’s billing practices. After the hospital self-disclosed concerns, the government concluded that the hospital billed federal healthcare programs for services the physician did not provide or properly supervise. 8 Nonprofit integrated healthcare services company agreed to pay $1 million to resolve FCA allegations that it submitted claims to Medicaid for services that were billed without proper or complete documentation, billed more than once, or otherwise improperly billed, and that it failed to return overpayments. 9 Hospital system and four of its hospitals agreed to pay $2.8 million to resolve FCA allegations that they submitted claims and retained overpayments related to a gynecologist’s services that were not medically necessary, not performed as represented or were never performed. The settlement resolved Ascension’s self-disclosure related to improper billing and additional qui tam allegations. 10 Medical center and county agreed to pay $11.4 million to resolve FCA allegations that they billed Medicare for inpatient admissions that were not reasonable or necessary, including patients admitted for social reasons and lack of available alternative placements. As a part of the settlement, the medical center and county entered into a five-year CIA with HHS-OIG. 11
Prime Healthcare Services; Dr. Prem Reddy; Dr. Siva Arunasalam
7/19/2021
$37.5 million
CHRISTUS St. Vincent Hospital
$563,809
7/21/2021
SpectraCare Health Systems, Inc.
$1 million
7/23/2021
Ascension Michigan; Providence Park Hospital; St. John Hospital and Medical Center; St. John Macomb Oakland Hospital; Ascension Crittenton Hospital
8/5/2021
$2.8 million
San Mateo County Medical Center; San Mateo County
8/6/2021
$11.4 million
7 https://www.justice.gov/opa/pr/prime-healthcare-services-and-two-doctors-agree-pay-375-million-settle-allegations-kickbacks. 8 https://www.justice.gov/usao-nm/pr/christus-st-vincent-hospital-santa-fe-new-mexico-reaches-settlement-fraudulent-health. 9 https://www.justice.gov/usao-mdal/pr/spectracare-health-systems-inc-agrees-pay-1-million. 10 https://www.justice.gov/opa/pr/ascension-michigan-pay-28-million-resolve-false-claims-act-allegations. 11 https://www.justice.gov/opa/pr/county-medical-center-and-county-agree-pay-114-million-resolve-false-claims-act-allegations.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 45
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