Adventist Health System to pay $115 million to settle suit over false claims
The settlement is one of the largest of its kind, representing a continued crackdown by federal authorities.
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The Adventist Health System has agreed to pay $115 million to settle allegations that it paid physicians for patient referrals and that it filed claims with codes that made conditions seem more severe, according to the U.S. Department of Justice.
The settlement is one of the largest of its kind, representing a continued crackdown by federal authorities on false claims filed to Medicare and Medicaid.
The agreement announced Monday admits no determination of liability, but resolves claims originally brought by employee whistleblowers who said Adventist paid physicians bonuses for referring patients.
[Also: Running list of notable 2015 healthcare frauds]
Whistleblowers Michael Payne, Melissa Church and Gloria Pryor worked at Adventist's hospital in Hendersonville, North Carolina; and Sherry Dorsey worked at Adventist's corporate office. Their lawsuits against Adventist were later enjoined by the Justice Department.
The nonprofit healthcare system operates hospitals and other health care facilities in 10 states.
The Stark law restricts the financial relationship between hospitals and physician referrals.
"Adventist-owned hospitals, such as Park Ridge, allegedly paid doctors' bonuses based on the number of test and procedures they ordered," said Acting U.S. Attorney Jill Westmoreland Rose of the Western District of North Carolina.
The settlement also resolves allegations that the health system used codes that triggered higher reimbursements for Medicare claims for patients to receive a larger reimbursement.
The whistleblowers are allowed to collect a share of the settlement, an amount which has yet to been determined, according to authorities.
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The plaintiffs alleged Adventist tried to control patient referrals by having its hospitals purchase physician practices or employ area physicians.
In March, Adventist Health System also agreed to pay $5.4 million to resolve False Claims Act allegations that it provided radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists, according to the Department of Justice.
Since 2009 when it was formed, the Health Care Fraud Prevention and Enforcement Action Team has recovered more than $15.2 billion in cases of alleged healthcare fraud.
Twitter: @SusanMorseHFN
