HOSPITALS AND HEALTH SYSTEMS
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
Hospital agreed to pay approximately $2.82 million to resolve self-disclosed FCA allegations that it submitted claims to Medicare and Medicaid for medically unnecessary cardiac catheterizations. 12 Physician group that formerly employed the physician who performed the procedures entered into a separate settlement regarding these allegations. Hospital agreed to pay more than $3.3 million to resolve FCA allegations that it improperly appended billing modifiers to claims, resulting in double billing for certain aspects of bundled payments. 13
Blessing Hospital
$2.82 million
8/17/2021
John Peter Smith Hospital
8/27/2021
$3.3 million
Sutter Health; Sutter Bay Medical Foundation d/b/a Palo Alto Medical Foundation, Sutter East Bay Medical Foundation, and Sutter Pacific Medical Foundation; Sutter Valley Medical Foundation d/b/a Sutter Gould Medical Foundation and Sutter Medical Foundation
Health system and affiliated entities agreed to pay $90 million to resolve FCA allegations that they submitted unsupported diagnosis codes for Medicare Advantage Plan beneficiaries to receive inflated reimbursements for beneficiaries. As part of the settlement, Sutter Health, Sutter Bay Medical Foundation and Sutter Valley Medical Foundation entered into a five-year CIA with HHS-OIG. 14
8/30/2021
$90 million
Health system agreed to pay more than $18.5 million to resolve self-disclosed FCA allegations that it submitted claims to Medicare for home health and hospice services that violated rules and regulations regarding certification of terminal illness, patient election of hospice care and physician face-to-face encounters with home health patients. 15 Hospital agreed to pay $18.2 million to resolve FCA allegations that it repurchased shares from physician-owners and resold the shares to younger physicians. In determining which physicians purchased the shares and how many each would be able to purchase, the hospital allegedly considered the value and volume of referrals generated by the physicians, in violation of the AKS and Stark Law. 16
Geisinger Community Health Services
$18.514 million
11/1/2021
Flower Mound Hospital Partners, LLC
12/2/2021
$18.2 million
12 https://www.justice.gov/usao-cdil/pr/federal-and-state-authorities-reach-settlement-blessing-hospital-over-medicare-and. 13 https://www.justice.gov/usao-ndtx/pr/hospital-pay-more-3-million-settle-whistleblower-suit. 14 https://www.justice.gov/opa/pr/sutter-health-and-affiliates-pay-90-million-settle-false-claims-act-allegations-mischarging. 15 https://www.justice.gov/usao-mdpa/pr/geisinger-community-health-services-agrees-18-million-civil-settlement. 16 https://www.justice.gov/opa/pr/flower-mound-hospital-pay-182-million-settle-federal-and-state-false-claims-act-allegations.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 46
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