Whistleblowers Reported Kickbacks for Patient Referrals and Claims for Inpatient Detoxification Services Provided Without the Necessary License
Three New York hospitals and a Missouri-based management company agreed to pay more than $8 million to resolve claims that they submitted false claims to Medicare and Medicaid for inpatient detoxification treatment provided to patients at the hospitals.
The defendants are Benedictine Hospital, Columbia Memorial Hospital, St. Joseph’s Medical Center, and SpecialCare Hospital Management Corporation.
The hospitals operated inpatient drug and alcohol detoxification programs under the name "New Vision" without the necessary licenses from the New York State Office of Alcoholism and Substance Abuse Services. When claims are submitted to Medicare and Medicaid for treatment provided without a proper license, the claims are considered “false claims” even if the treatment was medically necessary and properly performed.
The government also alleged that two of the hospitals, Columbia Memorial and St. Joseph’s, paid SpecialCare for patient referrals. Paying or exchanging anything of value in return for referrals of Medicare or Medicaid patients violates the Anti-Kickback law. Any claims submitted to Medicare or Medicaid for services provided after a kickback has been paid are considered “false claims” for purposes of the False Claims Act, even if the services were medically necessary and properly provided.
The government began its investigation after whistleblowers commenced qui tam or whistleblower lawsuits under the False Claims Act. Under that statute, individual citizens who have evidence of fraud may start a lawsuit on behalf of the government and earn a reward of between 15% and 30% of the amount the government recovers.
While the amount of the whistleblowers’ rewards have not yet been determined, the rewards should be in the range of $1.2 million and $2 million in this case based on the size of the settlement.
If you have evidence that a healthcare provider has paid kickbacks for patient referrals or submitted false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer to protect your rights. You may be entitled to a substantial reward and legal protections as a whistleblower.
Call John Howley, Esq. at (212) 601-2728 to arrange a free and confidential consultation.