Hospital Pays $41 Million to Settle Claims that “Unreasonably High” Cardiologist Salaries Violated the Physician Self-Referral Law
King’s Daughters Medical Center agreed to pay almost $41 million to settle allegation that it submitted false claims to Medicare and Medicaid for coronary stents and diagnostic catheterizations. The government claimed that the hospital violated the Stark Law, also known as the physician self-referral law, which prohibits certain types of financial relationships between hospitals and physicians. In this case, the government claimed that the hospital paid above-market salaries to cardiologists to induce them to refer patients to the hospital. Once an improper financial relationship exists, all claims for reimbursement from Medicare or Medicaid that arise out of that relationship are considered “false claims,” even if the patient received medically appropriate care. In this case, however, the government alleged that the financial relationship also resulted in medically unnecessary procedures. As a result of the improper financial incentives, the government alleged, Medicare and Medicaid were billed for medically unnecessary diagnostic catheterizations and cardiac stents. The government also alleged that the physicians falsified medical records to justify the unnecessary cardiac procedures. The Stark Law is very complex and contains exceptions to ensure that physicians can be fairly compensated. A related law known as the Anti-Kickback Statute is similarly complex and contains so-called “safe harbors.” Compliance with both laws is strictly enforced and must be properly documented. Violations of the Stark Law or Anti-Kickback Statute can result in civil penalties including treble damages, criminal prosecutions, and disciplinary action against the professionals involved. If you are being investigated for potential Stark Law violations, or if you have evidence that a hospital is engaged in improper financial relationships with physicians, then you should consult with an experienced Medicare and Medicaid fraud lawyer immediately. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email. John Howley, Esq.
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Former Employees Allege Hospice Submitted False Claims to Medicare for Palliative and Continuous Home Care Services
The United States government has decided to join a lawsuit started by whistleblowers against Home Care Hospice, Inc., a provider of hospice services, and the company’s owners. The lawsuit was started by two former employees who allege that the hospice company submitted false claims to Medicare for palliative and crisis care services. Under the qui tam or whistleblower provisions of the False Claims Act, individual citizens may start a lawsuit on behalf of the government and share in any recovery. The qui tam or whistleblower lawsuit was initially filed “under seal” (in secret). After conducting an investigation, the government decided to join the lawsuit. If the government recovers money from the defendants as a result of the lawsuit, the whistleblowers will be entitled to a reward of between 15% and 25% of the amount recovered. The former employees allege that the hospice company and its owners submitted false claims to Medicare for palliative care to patients who did not qualify. They also allege that the defendants submitted false claims for continuous home care services that were not medically necessary or not actually provided. The Medicare hospice benefit pays for palliative care for patients who have a life expectancy of six months or less. Palliative care is focused on providing the patient with relief from the pain and stress of terminal illnesses. A patient who chooses palliative care no longer receives medical services intended to cure the terminal illness. The whistleblowers allege that the hospice company and its owners created false medical records and submitted false claims to Medicare for patients who were not terminally ill. The whistleblowers also allege that the defendants created false medical records and submitted false claims to Medicare for continuous home care services that were not medically necessary or not actually provided. Continuous home care services, also known as crisis care, are provided to terminally ill patients who experience acute medical symptoms on a temporary basis. The crisis care services usually include skilled-nursing services for a short period to allow the patient to remain at home. Medicare reimburses continuous home care at a much higher rate than the usual palliative care services provided by hospices. If you have evidence that a hospice is submitting false claims to Medicare, then you should consult with an experienced Medicare fraud whistleblower lawyer immediately. You may be entitled to a significant reward and legal protections as a whistleblower. To arrange a free and confidential consultation with an experienced Medicare fraud whistleblower lawyer, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email. John Howley, Esq. Hospital Pays $2.5 Million to Settle Medicare and Medicaid Fraud Claims
A former employee of Baptist Health System Inc. was awarded a $425,000 whistleblower reward for helping the government recover $2.5 million in allegedly false claims submitted to Medicare and Medicaid. The former employee gave the government evidence that the hospital system billed Medicare and Medicaid for services and drugs that were not medically necessary. According to the whistleblower lawsuit, two neurologists at the hospital system misdiagnosed patients with multiple sclerosis and other neurological disorders. As a result of the misdiagnoses, the hospital system billed Medicare and Medicaid for medically unnecessary services and drugs. The hospital system placed one of the neurologists on administrative leave, but it did not disclose the problems to the government until a year later. The government’s investigation began when a former hospital employee brought a qui tam or whistleblower lawsuit. A whistleblower lawsuit is filed with the court “under seal” (in secret). At the same time, the whistleblower gives their evidence to the government, and the government is required to conduct an investigation. If the government recovers money as a result of the evidence provided, then the whistleblower is entitled to a reward of between 15% and 30% of the amount the government recovers. In this case, the whistleblower was awarded 17% of the amount recovered or $425,000. If you have evidence that a hospital or other medical provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced Medicare fraud whistleblower lawyer immediately to protect your rights. Do not delay. The reward is available only to the first whistleblower who provides evidence to the government. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728 or click here to reach our law offices via email. John Howley, Esq. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728 Hospital Settles Medicare Fraud Claims Based on Stark Law Violations Halifax Hospital Medical Center and an affiliate will pay $85 million to settle claims that they submitted false claims to Medicare for services that violated the physician self-referral provisions of the Stark Law. The Stark Law prohibits hospitals from billing Medicare for certain services referred by physicians who have a financial relationship with the hospital. The financial relationship may take the form of salaries, benefits, consulting contracts, or below-market office space. The whistleblower complaint in this case alleged that contracts between Halifax and six medical oncologists violated the prohibition on physician self-referrals in the Stark Law. Specifically, the contracts provided an incentive bonus based on the value of prescription drugs and tests that the oncologists ordered and the hospital then billed to Medicare. The complaint also alleged that the hospital violated the Stark Law by paying three neurosurgeons who referred patients to the hospital more than the fair market value of their services. The settlement resolves a whistleblower lawsuit brought by a former hospital employee under the qui tam or whistleblower provisions of the False Claims Act. The qui tam provisions allow an individual citizen to file a lawsuit “under seal” (in secret) on behalf of the government and share in the amount the government recovers. After investigating the claims, the government may choose to take over the lawsuit or allow the whistleblower to proceed on its behalf. The whistleblower in this case, Elin Baklid-Kunz, will receive a $20.8 million reward for helping the government uncover the fraud and prove the allegations. Qui tam or whistleblower lawsuits are different from ordinary lawsuits in several respects. The procedures for filing the lawsuit and disclosing evidence to the government must be followed correctly or the case will be dismissed. In addition, the whistleblower must produce evidence of the false claims, not merely allegations, at the very beginning of the lawsuit. If you have evidence that a hospital is violating the Stark Law or making other types of false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and other whistleblower protections if you prepare your case properly. To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. 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