Consumer Fraud

GA Hospital, Physician Settle Whistleblower Lawsuit For $25 Million

whistleblower 5 370x210 GA Hospital, Physician Settle Whistleblower Lawsuit For $25 MillionA Columbus, Ga., hospital system and an affiliated physician have agreed to pay the U.S. and State of Georgia more than $25 million to settle a whistleblower’s allegations that they violated the federal False Claims Act, the Stark Statute, and the Georgia False Medicaid Claims Act.

The settlements resolve two lawsuits filed by Richard Barker, a former Columbus Regional executive, in federal court in Columbus, Ga.  Mr. Baker filed the lawsuits under the whistleblower provisions of the federal and state False Claims Acts, which permit individuals to sue on behalf of the federal and state governments and share in any recovery.

According to the U.S. Justice Department, Columbus Regional Healthcare System and Dr. Andrew Pippas submitted claims to federal health care programs for reimbursement that overstated the level of services they provided.

The Stark Law prohibits physicians from referring certain health services for Medicare and Medicaid patients to hospitals with which they have a financial relationship. U.S. prosecutors investigated Mr. Barker’s allegations and chose to back them, finding that between 2003 and 2013, Columbus Regional provided excessive salary and directorship payments to Dr. Pippas in return for the referrals – an arrangement that violated the Stark Law.

U.S. prosecutors also alleged that from May 2006 through May 2013, Columbus Regional submitted false, inflated claims to federal health care programs for certain services, and that between 2010 and 2012, they submitted claims for radiation therapy at higher levels than the therapy that was provided.

Of the $25.425 million that Columbus Regional and Dr. Pippas agreed to pay, $24,666,040 will go back to the federal government for federal health care program losses and $758,960 will go to the state of Georgia for its share of Medicaid losses.

The agreement also requires Columbus Regional to enter into a Corporate Integrity Agreement with the Department of Health and Human Services-Office of the Inspector General. Under the agreement, Columbus Regional must implement a number of measures designed to detect and avoid any future fraud against Medicare and Medicaid.

“Today’s settlement demonstrates our continuing vigilance to ensure that health care referrals are based solely on the medical needs of the patient and that health care providers bill the government only for the care they provide,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.  “Health care providers who seek to profit at the expense of taxpayers will face serious consequences.”

Source: U.S. Department of Justice