Consumer Fraud

Whistleblower Complaint Helps U.S. Recover $4.1 million From Ohio Hospital

Pills Stethascope on Money 435x289 Whistleblower Complaint Helps U.S. Recover $4.1 million From Ohio HospitalA Cincinnati hospital and its parent company will pay the U.S. government $4.1 million to resolve allegations stemming from a whistleblower complaint that performed unnecessary spinal surgeries on Medicare and Medicaid patients to boost their federal reimbursements.

According to the U.S. Justice Department, West Chester Hospital, part of the UC Health hospital network, knowingly submitted false claims to federal health care programs from 2009 and 2013 for unnecessary surgeries performed by Dr. Abubakar Atiq Durrani, a surgeon from Mason, Ohio, who had admitting privileges at West Chester Hospital.

Dr. Durrani was arrested in July 2013 and charged with federal health care fraud violations for performing medically unnecessary surgeries on patients in Ohio and Kentucky for personal gain. Federal authorities believe Dr. Durrani fled the country after his arraignment; he remains a fugitive.

The settlement resolves a lawsuit filed under the whistleblower provisions of the False Claims Act, which permit private parties to file suit on behalf of the United States for false claims. A group of former patients of Dr. Durrani and West Chester Hospital filed the lawsuit in an Ohio federal court. The Justice Department has not said how much of the settlement will be awarded to the whistleblowers, but under the law they are entitled to share up to 30 percent of the $4.1-million recovery.

Approximately $72,000 of the settlement will go back to the states of Ohio and Kentucky for losses to their Medicaid programs caused by the fraudulent scheme.

“Any time greed replaces medical necessity as the primary factor in performing invasive procedures and surgeries on Medicare and Medicaid patients, our most vulnerable citizens – the elderly, disabled, and economically disadvantaged – are imperiled,” said Health and Human Services Special Agent Lamont Pugh, who helped prosecute the case. “Medical businesses and physicians who unnecessarily place patients at risk to boost profits will be held accountable for their actions.

Diana Lara, hospital spokesperson for UC Health, issued the following statement in response to the settlement announcement:

“We expressly deny the government’s allegations and admit no liability, but to avoid delay, uncertainty and expense of litigation, UC Health and West Chester voluntarily pursued and entered into this settlement. We have agreed to refund certain payments under Medicare and Medicaid in connection with procedures performed by a surgeon at West Chester Hospital. The surgeon was not an employee of UC Health or West Chester Hospital but had privileges at West Chester Hospital for a time.”

Source: U.S. Department of Justice