Consumer Fraud

Whistleblower Complaint Recovers $5.5 million From Missouri Hospitals

whistleblower Whistleblower Complaint Recovers $5.5 million From Missouri HospitalsTwo Missouri hospitals will pay the United States $5.5 million to resolve a whistleblower complaint alleging they violated the False Claims Act by rewarding physicians for referring Medicare patients to the hospitals.

According to the U.S. Justice Department, the whistleblower complaint accused Mercy Health Springfield Communities and Mercy Clinic Springfield Communities of engaging in prohibited financial arrangements with physicians by rewarding them with bonuses based on the value of the Medicare patient referrals the physicians directed to their clinics.

Together, the defendants own and operate a hospital in Springfield, Mo., and several health care clinics in southwestern Missouri.

Federal law restricts the kind of financial relationships that hospitals may have with doctors who refer patients to them to preserve the integrity of the Medicare system and to ensure that Medicare beneficiaries receive care based on their medical needs rather than a physician’s financial incentives.

“Health care organizations paying physicians based on referrals – as alleged in this case – undermines public trust in medical institutions and the financial integrity of federal health care programs,” said Health and Human Services Special Agent Gerald Roy.

Dr. Jean Moore, a physician employed by one of the defendant hospitals, filed the complaint under the qui tam, or “whistleblower” provisions of the False Claims Act, which authorizes private citizens to sue on behalf of the government for false claims and share a percentage of any recovery.  Dr. Moore, who successfully argued that the Missouri hospitals’ improper financial arrangements with physicians led to the submission of false claims to Medicare, is to receive $825,000 from the recovery, the Justice Department said.

Source: U.S. Department of Justice