Sanford Health must hire auditor to monitor billing after whistleblower settlement

Sioux Falls, S.D.-based Sanford Health has entered into a corporate integrity agreement with the HHS Office of Inspector General that requires the health system to hire an independent auditor to monitor Medicare and Medicaid claims, according to the Argus Leader.

The 36-page agreement is designed to ensure Sanford's continued participation in federal programs such as Medicare, the newspaper reported.

It requires Sanford to maintain a compliance program, implement a risk assessment program and hire an independent review organization to review billing at Sanford Medical Center, the Department of Justice said.

Specifically, Sanford, which recently called off its merger with Des Moines, Iowa-based UnityPoint Health, will be required to conduct at least annual training for employees regarding the health system's corporate integrity agreement requirements and compliance program and the requirements of the federal Anti-Kickback Statute and Stark Law.

The health system will also be required to submit reports each year for the next five years certifying compliance with the agreement and federal laws, according to the Argus Leader.

The corporate integrity agreement is coexistent with a $20.25 million civil settlement Sanford reached in October to resolve False Claims Act allegations. 

The settlement resolved allegations brought in a whistleblower lawsuit that Sanford officials knew one of its neurosurgeons, Wilson Asfora, MD, was receiving kickbacks from his use of implantable devices distributed by a company he owned. 

The federal government said Sanford allowed the physician to financially benefit from the devices he used in surgeries and continued to submit claims to federal healthcare programs for these surgeries, including procedures that weren't medically necessary.

Sanford confirmed the corporate integrity agreement to the Argus Leader and told the newspaper the agreement includes compliance requirements that are already implemented.

"Sanford is confident that all the requirements set forth in the corporate integrity agreement will be met and in a timely fashion," the health system said.


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