Healthcare in Australia

A settlement has been reached to resolve False Claims Act Allegations against Dr. Walter Janke, his wife, Lalita Janke, and Vero Beach, Fla.-based Medical Resources L.L.C. (MR).  They are accused of submitting false diagnosis codes to Medicare.

The Jankes were the owners of America’s Health Choice Medical Plans Inc. (AHC), a Medicare Advantage Organization (MAO), approved by the federal health care program to provide health care to enrolled Medicare beneficiaries. The Jankes also owned MR, AHC’s primary care provider. AHC and MR are no longer doing business.

The United States allged that the Jankes and MR violated the False Claims Act by causing AHC to falsely increase the severity of beneficiary diagnoses to obtain higher Medicare payments. Under the Medicare Advantage Program, MAO's are paid more to provide services for members with serious and/or chronic medical conditions then they are for relatively healthy members.

In addition to suing the Jankes and MR, the United States successfully petitioned the court to freeze approximately $20 million of the Janke's assets believed to be the proceeds of their unlawful scheme. A portion of the Janke’s frozen assets, along with monies resulting from the dissolution of AHC now held in receivership by the Florida Department of Financial Services, will be used to pay the settlement.

A settlement has been reached to Resolve False Claims Act allegations against Mercy Hospital Inc (d/b/a Mercy Medical Center) of Springfield, MA, who is accused of failing to adhere to Medicare guidelines.

In June 2007, Mercy disclosed to the Department of Health and Human Services Office of Inspector General that it could not demonstrate that it had provided the required level of therapy.

The settlement resulted from the company’s disclosure.  The allegations were that Mercy Medical Center, between 2005 and 2006, failed to provide, or failed to document that it provided, the minimum number of hours of rehabilitation therapy required under Medicare guidelines.

Under Medicare, inpatient rehabilitation hospitals must provide a minimum amount of rehabilitative therapy to their patients.

A settlement has been reached in a whistleblower class action lawsuit brought against McAllen Hospitals LP, d/b/a/ South Texas Health System, who is accused of paying illegal compensation to doctors in order to induce them to refer patients to hospitals within the group.

According to settlement details, the federal government will receive $25,208,333 and the state of Texas will receive $2,291,667 for claims submitted to the state Medicaid program. The whistleblower will receive $5.5 million from the proceeds of the settlement.

Originally filed in 2005, the federal government alleged that the defendants had entered into financial relationships with several doctors in McAllen in order to induce them to refer patients to the defendants’ hospitals. The government alleged that these payments were disguised through a series of sham contracts, including medical directorships and lease agreements. Under the Stark Statute, Medicare providers are prohibited from billing Medicare for referrals from doctors with whom the providers have a financial relationship, unless that relationship falls within certain exceptions.

The Indiana hospitals include St. Francis Hospital in Beech Grove, Deaconess Hospital in Evansville and St. John’s Hospital System in Anderson. The hospitals have agreed to pay the United States $3,158,629, $2,110,034 and $826,256, respectively.

The Alabama hospitals include St. Vincent’s East Hospital and St. Vincent’s Birmingham Hospital, both located in Birmingham, and Providence Hospital, located in Mobile. These facilities have agreed to pay the United States $1,459,395, $422,748 and $381,713, respectively.

The whistleblowers will receive a $1.4 Million recovery of the government's settlement.

These allegations stem from a whistleblower case filed in 2008. The United States asserted that, from 2002 to 2008, the six hospitals overcharged Medicare each time they performed kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. In many cases, the procedure can be performed safely as an out-patient surgery, but the government contends that the hospitals performed the procedure on an in-patient basis in order to increase their Medicare billings.

A settlement has been reached in a whistleblower class action lawsuit brought against seven hospitals located in Florida, Mississippi, Texas, South Carolina, North Carolina and Alabama. They are accused of submitting false claims to Medicare.

The settling facilities include the following:

Lakeland Regional Medical Center, Lakeland, Fla. ($1,660,134.49)

The Health Care Authority of Morgan County – City of Decatur dba Decatur General Hospital, Decatur, Ala. ($537,892.88)

St. Dominic-Jackson Memorial Hospital, Jackson, Miss. ($555,949.35)

Seton Medical Center, Austin, Texas ($1,232,955.91)

Greenville Memorial Hospital, Greenville, S.C. ($1,026,764.01)

Presbyterian Orthopaedic Hospital, Charlotte, N.C.($637,872.57)

The Health Care Authority of Lauderdale County and the City of Florence, Ala., dba the Coffee Health Group, fka Eliza Coffee Memorial Hospital ($676,038.00)

The settlements with these facilities follow the settlements that the government reached in May 2009, September 2009, and May 2010 with 18 other hospitals for kyphoplasty-related Medicare claims, as well as the government’s May 2008 settlement with Medtronic Spine LLC, corporate successor to Kyphon Inc. The whistleblowers will receive a total of approximately $1.1 million as their share of the settlement proceeds.

Originally filed in 2008, the United States alleged that these hospitals overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. In many cases, the procedure can be performed safely as a less costly out-patient procedure, but the government contends that the hospitals performed the procedure on an in-patient basis in order to increase their Medicare billings.