St. Peter's Health paying $10.8 million over alleged false claims
DOJ says St. Peter fraudulently submitted claims for services performed by an oncology doctor.
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St. Peter's Health, based out of Helena, Montana, will pay about $10.8 million to resolve False Claims Act allegations that it fraudulently submitted claims to federal healthcare programs for services performed by an oncology doctor.
According to the agreement, St. Peter's violated the False Claims Act by submitting false claims for payments to federal healthcare programs relating to services performed and referred by Dr. Thomas Weiner, an oncologist employed at its cancer treatment center.
WHAT'S THE IMPACT?
The government alleged that between Jan. 1, 2015, and Dec. 31, 2020, St. Peter's, relying on Dr. Weiner's documentation and certification, submitted claims which were determined to be false. The Department of Justice said that St. Peter's knew, or should have known, that Dr. Weiner submitted claims for office visits that were coded at a higher level of service than was actually performed – or did not meet the requirements of a significant, separately identifiable service when performed on the same day as administration of chemotherapy.
Also, relying on Dr. Weiner's documentation and certification, St. Peter's allegedly compensated Dr. Weiner with a salary that was based on the false claims, and therefore, caused his salary to be inconsistent with fair market value.
The settlement agreement credits St. Peter's for voluntarily self-disclosing the alleged misconduct. St. Peter's also performed and disclosed the results of an internal investigation, disclosed documents beyond existing business practices or legal requirements, identified individuals who were aware of relevant information or conduct, made officers and employees available for interviews, assisted in determining the losses caused by the misconduct and has enhanced its corporate compliance program, according to the DOJ.
St. Peter's will pay the $10.8 million no later than 30 days after the effective date of the agreement.
"One of the purposes of the False Claims Act is to protect the American taxpayer from paying for false claims submitted by health care providers to federal healthcare programs," said Jesse Laslovich, U.S. attorney for the District of Montana. "Our healthcare providers simply must submit accurate claims when billing these taxpayer-supported federal healthcare programs for services."
The U.S. Attorney's Office handled the matter. The U.S. Department of Health and Human Services Office of Inspector General and U.S. Department of Veterans Affairs Office of Inspector General provided investigative support.
THE LARGER TREND
Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023, and, of that total, more than $1.8 billion related to matters that involved the healthcare industry – including managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities and physicians, according to the U.S. Department of Justice.
The DOJ said the government and whistleblowers were party to 543 settlements and judgments, the highest number of settlements and judgments in a single year. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $75 billion.
Overall, healthcare fraud was responsible for two-thirds of the recovered amount in 2023.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
