Government

A settlement has been reached in a whistleblower class action lawsuit brought against two New Jersey hospitals,Our Lady of Lourdes Medical Center (OLL) in Camden, N.J., and Lourdes Medical Center of Burlington County (LMC) in Willingboro, N.J. They are accused of fraudulently inflating charges to Medicare.

The whistleblower will receive $356,000, plus interest.

Originally filed in 2005, The United States alleged that LMC fraudulently inflated its charges to Medicare patients to obtain enhanced reimbursement from Medicare. In addition to its standard payment system, Medicare provides supplemental reimbursement, called "outlier payments," to hospitals and other health care providers in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payments system to give hospitals the incentive to treat inpatients whose care requires unusually high costs. The lawsuit alleged that the hospital inflated its charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid.

The United States conducted a separate investigation of OLL. The government alleged, as a result of that investigation, that the hospital also wrongfully obtained excessive outlier payments.

A settlement has been reached in a whistleblower class action lawsuit brought against Visiting Physicians Association who is accused of submitting false claims to Medicare, TRICARE and the Michigan Medicaid program.

The lawsuit was one of four filed against the defendants.  The whistleblowers will share in a recovery of approximately $1.7 million.

The United States alleged that Visiting Physicians Association submitted claims to the Medicare, TRICARE and Michigan Medicaid for unnecessary home visits and care plan oversight services, for unnecessary tests and procedures, and for more complex evaluation and management services than the services that Visiting Physicians Association actually provided.

A settlement has been reached in a whistleblower class action lawsuit brought against Brookhaven Memorial Hospital who is accused of fraudulently inflating charges to Medicare.

The United States settled for $2.92 million, plus interest and the whistleblower will receive roughly $613,000, plus interest.

The case was originally filed by a whistleblower in 2005 against two different hospitals.  The United States alleged that the hospitals defrauded Medicare by fraudulently inflating their charges to Medicare patients to obtain enhanced reimbursement from Medicare.

In addition to its standard payment system, Medicare provides supplemental reimbursement, called "outlier payments," to hospitals and other health care providers in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payments system to ensure that hospitals possess the incentive to treat inpatients whose care requires unusually high costs. The lawsuit alleged that the hospitals inflated their charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid.

A settlement has been reached in a whistleblower class action lawsuit brought against Trinitas Regional Medical Center who is accused of fraudulently inflating charges to Medicare.

The United States settled for $3.02 million, plus interest and the whistleblower will receive a share of the recovery totalling approximately $679,000.

The case was originally filed by a whistleblower in 2005 against two different hospitals.  The United States alleged that the hospitals defrauded Medicare by fraudulently inflating their charges to Medicare patients to obtain enhanced reimbursement from Medicare.

In addition to its standard payment system, Medicare provides supplemental reimbursement, called "outlier payments," to hospitals and other health care providers in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payments system to ensure that hospitals possess the incentive to treat inpatients whose care requires unusually high costs. The lawsuit alleged that the hospitals inflated their charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid.

A settlement has been reached to resolve False Claims Act allegations brought against Omni Home Care, and its parent corporation, Omni Home Health.  They are accused of failing to obtain certain required physician approvals before submitting bills for home health services to Medicare.

In August 2008, Omni submitted a disclosure to the Office of Inspector General, Department of Health and Human Services, in which Omni stated that the required physician signatures were not timely obtained for certain services provided at its Evansville, Ind., facility. 

The settlement reached resolves the violations mentioned in the Company's disclosure.

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 to resolve False Claims Act allegations against Covenant Medical Center who is accused of submitting false claims to Medicare by having financial relationships with five physicians that violated the Stark Law.

The federal government alleged that Covenant submitted false claims to Medicare by having financial relationships with five physicians that violated the Stark Law. The Stark Law prohibits a hospital from profiting from referrals of patients made by a physician with whom the hospital has an improper compensation arrangement. An arrangement is improper if a physician is paid above fair market value for their services and that compensation is not commercially reasonable. The Stark Law is intended to ensure that physicians' medical judgments are not compromised by improper financial incentives and are based solely on the best interests of the patient.

The United States alleged that Covenant violated the Stark Law by paying commercially unreasonable compensation, far above fair market value, to five employed physicians who referred their patients to Covenant for treatment. These physicians were among the highest paid hospital-employed physicians not just in Iowa, but in the entire United States.

A settlement has been reached in a whistleblower class action lawsuit brought against Dr. Gabriel DeCandido who is accused of defrauding the Medicare program.

According to the settlement, the court permitted the government to seize five of his vehicles and garnish $976,000 that Dr. DeCandido transferred to his wife.The whistleblower's share of the recovery is $306,000.

This case was originally filed by a whistleblower in January 2005.  The United States alleged Dr. DeCandido violated the False Claims Act by billing the Medicare program for higher levels of service than he actually rendered to patients and by billing for services not provided. The government presented sufficient evidence showing that Dr. DeCandido attempted to hide and transfer his assets to avoid having to pay a judgment to the United States.

A settlement has been reached in a whistleblower class action lawsuit brought against HealthEast Care System. Three HealthEast Care System hospitals are accused of submitting false claims to Medicare.

The two whistleblowers' recovery amounts from this lawsuit that was filed in 2008, were not specified.

The United States complaint asserts that three HealthEast Care System hospitals overcharged Medicare from 2002 to 2007 by thousands of dollars each time they performed kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. The procedure can be performed safely as an outpatient surgery, but the government contends that the HealthEast hospitals performed the procedure on an inpatient basis in order to increase their Medicare billings.