In key enforcement actions announced from April 12 to 18 by the U.S Department of Justice (DOJ) that involved the health care industry, all the cases involved companies facing allegations of false claims. Here is a quick summary of four main cases:
April 12: The DOJ announced that non-profit health system Providence Health & Services, which is based in Washington State, agreed to pay nearly $22.7 million to settle accusations of fraudulent billing. The organization, which operates hospitals across seven states, allegedly billed federal health care programs, including Medicare and Medicaid, for medically unnecessary neurosurgery procedures. Providence paid $22,690,458 in a joint settlement between the organization, the State of Washington, and the United States, according to the DOJ.1
April 12: Florida-based pain management company Physician Partners of America LLC (PPOA), along with founder Rodolfo Gari and ex-chief medical officer Dr. Abraham Rivera paid $24.5 million to settle False Claims Act (FCA) allegations. According to the DOJ, Gari, Rivera, and PPOA made unlawful payments to physicians employed by the company and billed federal health care programs for medically unnecessary testing and services. They also allegedly made a false statement involving a loan they received through the Small Business Administration’s Paycheck Protection Program. In addition to Gari, Rivera, and PPOA, some of the company’s affiliates will also be on the hook for a portion of the settlement amount, including Medical DNA Labs LLC, Medical Tox Labs LLC, Physician Partners of America CRNA Holdings LLC, the Texas Pain Relief Group, and the Florida Pain Relief Group.2
April 13: Georgia-based anesthesia management company Care Plus Management, LLC, its two founders Paul D. Weir and John R. Morgan, MD, and 18 of the entities it owned and operated settled FCA and kickback allegations for $7.2 million. The group is accused of being involved in a kickback scheme where it paid physicians a portion of Care Plus profits and provided various subsidies in exchange for the physicians referring their patients to Care Plus for anesthesia services, according to the DOJ.3
April 18: A medical clinic with locations in Colorado, as well as its owner and chief executive officer (CEO), agreed to pay a minimum of $125,000 to settle FCA-related allegations. The clinic, Springbok Health Inc., and owner/CEO Mark Jankelow are accused of billing Medicaid and Medicare for prolonged and high-complexity management and medical evaluation services that were never actually provided, according to the DOJ. The settlement amount could reach as high as $335,494, based on Jankelow and Springbok’s ability to pay.4
References:
- https://www.justice.gov/usao-edwa/pr/providence-health-services-agrees-pay-227-million-resolve-liability-medically
- https://www.justice.gov/opa/pr/physician-partners-america-pay-245-million-settle-allegations-unnecessary-testing-improper
- https://www.justice.gov/usao-ndga/pr/paul-d-weir-john-r-morgan-md-care-plus-management-llc-and-anesthesia-entities-pay-72
- https://www.justice.gov/opa/pr/colorado-substance-abuse-treatment-clinic-and-owner-agree-settle-false-claims-act-allegations