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Three New Settlements in Health Care Fraud

Three New Settlements in Health Care Fraud

Sometimes it can feel as if fighting health care fraud is like bailing out a leaky boat with a thimble. But take heart: In August, 2018, three False Claims Act (FCA) health care settlements took place that might not have come to light if whistleblowers hadn’t been willing to get involved. Two cases involved physician kickbacks, and one concerned upcoding.

When people blow the whistle, it benefits all of us. Are you thinking about blowing the whistle on health care fraud or other actionable False Claims Act wrongdoing? The Louthian Law Firm can help you put together your claim so that the government is more persuaded to intervene. Give them a call for a confidential and free consultation about your case.

Prime Healthcare Services: $65 Million

Prime Healthcare Services, Inc., and related companies (Prime), and its founder and CEO, Dr. Prem Reddy, will pay $65 million to settle allegations that Prime knowingly submitted false Medicare claims under the False Claims Act. It is claimed that 14 Prime hospitals in California admitted patients to hospitals when they needed only outpatient care. Medicare was then billed for care appropriate to more expensive diagnoses than the patients actually had, which is upcoding. Prime will pay $61.75 million and Dr. Reddy will pay $3.25 million. Prime is one of the biggest hospital systems in the U.S.

The $65 million settlement resolves claims that Prime deliberately engaged in schemes to increase admissions of Medicare patients at 14 Prime hospitals from 2006 through 2013. Prime also agreed with the U.S. Department of Health and Human Services Office of Inspector General that they would participate in a Corporate Integrity Agreement that would monitor their compliance with regulations. The agreement lasts five years.

The whistleblower, Karin Berntsen, formerly worked as the Director of Performance Improvement at a Prime facility, Alvarado Hospital Medical Center in San Diego. She will receive more than $17.2 million from the settlement amount for the part she played.

William Beaumont Hospital System: $84.5 Million

A Detroit, Michigan, regional hospital system, William Beaumont Hospital, has agreed to pay $84.5 million to resolve False Claims Act allegations that they conducted improper relationships with eight referring doctors. Beaumont supposedly submitted false claims to Medicare, Medicaid, and TRICARE. In doing so, they violated the Anti-Kickback Statute and the Stark Law.

The Anti-Kickback Statute prohibits secret financial arrangements to expedite a transaction that benefits the medical professionals or entities involved. The Stark Law forbids a doctor from receiving any form of financial gain for referring a patient for tests or other medical services and regulates Medicare and Medicaid patient referrals.

Between 2004 and 2012, Beaumont allegedly compensated certain doctors in various ways that were well in excess of fair market value in exchange for their referrals of patients to the hospital system. Besides the $84.5 million settlement, Beaumont also agreed with the U.S. Department of Health and Human Services Office of Inspector General that they would participate in a Corporate Integrity Agreement that would monitor their compliance with regulations for five years.

Four separate whistleblower lawsuits were involved in bringing Beaumont to justice. The whistleblowers’ shares of the settlement have not yet been determined.

Post Acute Medical: $13.2 Million

A Pennsylvania-based operator of rehabilitation and long-term care hospitals, Post Acute Medical, LLC (PAM), and affiliated companies, agreed to settle with the United States government and the states of Texas and Louisiana under the federal False Claims Act and state false claims statutes. The settlement amount, approximately $13.2 million, alleges that PAM violated both the Anti-Kickback Statute and the Stark Law. Doing so resulted in the submission of false claims to Medicare and certain Medicaid programs funded by both the U.S. government and state governments. PAM will pay the U.S. $13,031,502. Texas will receive $114,016, and Louisiana will get $22,482.

Besides the $13.2 million settlement, PAM also agreed with the U.S. Department of Health and Human Services Office of Inspector General that they would participate in a Corporate Integrity Agreement that would monitor their compliance with regulations for five years.

Since PAM’s founding in 2006, they had entered into many different contracts for physicians’ services with its hospitals. It is claimed, however, that the contracts were actually kickback arrangements in disguise, meant to persuade doctors to refer their patients to PAM facilities.

The whistleblower who brought the allegations under the False Claims Act, Douglas Johnson, will receive $2,345,670 from the federal government’s recovery for his part in the case.

Working tirelessly with whistleblowers to shed light on fraudulent practices.

If you think you have the facts needed to bring a whistleblower case, the experienced whistleblower attorneys at the Louthian Law Firm can review your case and help you file the appropriate disclosure statement. Under some circumstances, the government will intervene, or join in your lawsuit.

Your chances of succeeding are greater if your whistleblower claim is substantive, clear, and to the point. Because of this, meeting with a qualified whistleblower attorney can increase your chances of winning. The Louthian Law Firm can help you form your claim so that the government will be more inclined to intervene in your case. Sometimes, government intervention can increase the chances of recovering award money. But even if the government decides not to intervene, it could still be a good idea to pursue your case. If you decide to do so, our strong support system can assist you through every step of the process.

For a free, confidential evaluation of your case, call the Louthian Law Firm today or, if you prefer, use our online contact form.

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