HOSPITALS AND HEALTH SYSTEMS
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
Hospital agreed to pay more than $320,000 to resolve FCA allegations that it submitted claims to federal healthcare programs using the NPIs of credentialed physicians for services actually performed by non-credentialed physicians. 1 Hospital agreed to pay more than $179,000 to resolve self-disclosed Civil Monetary Penalties Law (CMPL) allegations that it submitted claims for nursing services provided by individuals who were not properly licensed. 2 Hospital agreed to pay more than $67,000 to resolve self-disclosed CMPL allegations that it employed a person that it knew or should have known was excluded from participation in federal healthcare programs. 3 Health system and affiliated physician practice agreed to pay $10 million to resolve allegations that they submitted claims to Medicare for concurrent and overlapping surgeries in violation of regulations and reimbursement policies. As part of the settlement, the physician practice entered into a five-year CIA with HHS-OIG. 4 Health system that operates dental clinics agreed to pay $2.7 million to resolve federal and state FCA allegations that it submitted claims to Medicaid for dental services performed using hand pieces that had not been properly sterilized. 5 Hospital system agreed to pay $21.25 million to resolve FCA allegations that it compensated physicians in excess of FMV in exchange for the referrals of patients, in violation of the AKS and Stark Law. Cleveland Clinic Foundation, which acquired the hospital system in 2015, self-disclosed the physician compensation arrangements and received cooperation credit in the settlement. The settlement also resolves related allegations made by a former director of internal audit in a qui tam action. 6
Grant Memorial Hospital
2/24/2021
$320,175
TidalHealth Nanticoke
$179,725
3/5/2021
Swedish Health Services d/b/a Swedish Medical Center
$67,359
3/19/2021
Dignity Health d/b/a St. Joseph’s Hospital; Neurosurgical Associates, LTD
5/5/2021
$10 million
Upper Allegheny Health System
5/25/2021
$2.7 million
Akron General Health System, Inc.
7/2/2021
$21.25 million
1 https://www.justice.gov/usao-ndwv/pr/west-virginia-hospital-pay-more-300000-medicare-fraud. 2 https://oig.hhs.gov/fraud/enforcement/tidalhealth-nanticoke-agreed-to-pay-179000-for-allegedly-violating-the-civil-monetary-penalties-law-by-submitting-claims-for-services-by-unlicensed-nurse/. 3 https://oig.hhs.gov/fraud/enforcement/swedish-medical-center-agreed-to-pay-67000-for-allegedly-violating-the-civil-monetary-penalties-law-by-employing-an-excluded-individual/. 4 https://www.justice.gov/usao-az/pr/neurosurgical-associates-ltd-and-dignity-health-dba-st-josephs-hospital-paid-10-million. 5 https://www.justice.gov/usao-wdny/pr/upper-allegheny-health-system-pay-27-million-settle-false-claims-act-allegations. 6 https://www.justice.gov/opa/pr/northern-ohio-health-system-agrees-pay-over-21-million-resolve-false-claims-act-allegations.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 44
Powered by FlippingBook