A settlement has been reached to resolve False Claims Act allegations against William Beaumont Hospital.
The allegations arose from lawsuits that claimed William Beaumont Hospital of improper relationships with eight referring physicians, resulting in the submission of false claims to the Medicare, Medicaid and TRICARE programs.
Reportedly, the settlement resolved allegations that between 2004 and 2012, the hospital system overpaid the doctors and provided them with free or below-market office space and other perks so that they would refer more patients to Beaumont. Furthermore, the settlement resolves claims that Beaumont allegedly misrepresented that a CT radiology center qualified as an outpatient department of Beaumont in claims to federal health care programs.
According to the Justice Department, William Beaumont Hospital may have violated the federal Stark Law, Anti-Kickback Statute and False Claims Act, as it affected claims made to Medicare, Medicaid and TRICARE programs. The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce patient referrals covered by Medicare and Medicaid. The Stark Law prohibits a hospital from billing Medicare for services referred by doctors with whom the hospital has an improper financial arrangement, such as excessive compensation.
“Health care providers that offer or accept financial incentives in exchange for patient referrals undermine both the financial integrity of federal health care programs and the public’s trust in medical institutions,” said HHS-OIG Special Agent in Charge Lamont Pugh. “Our agency will continue to protect both patients and taxpayers by holding those who engage in fraudulent kickback schemes accountable.”
As a result of this settlement, Beaumont will pay $82.74 million to the United States and $1.76 million to the State of Michigan. In addition, Beaumont has entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General which includes, among other things, an arrangements review to be conducted by an Independent Review Organization.
The whistleblower’s shares to be awarded in the cases have not yet been determined.
