Adventist Health System to pay record-breaking $118.7M to settle improper physician compensation claims

Altamonte Springs, Fla.-based Adventist Health System has agreed to pay $118.7 million to the federal government and to the states of Florida, North Carolina, Tennessee and Texas to settle allegations it violated the False Claims Act by maintaining improper compensation arrangements with referring physicians.

The settlement resolves allegations that Adventist paid bonuses to employed physicians based on a formula that improperly took into account the value of the physicians' referrals to Adventist hospitals, according to the Department of Justice. Adventist submitted false claims to the Medicare and Medicaid programs for services rendered to patients by the physicians who received the improper bonuses, according to the lawsuit.

The settlement also resolves claims that Adventist submitted bills to Medicare for its employed physicians' professional services containing certain improper coding modifiers, according to the DOJ.

The allegations against the health system were originally brought by three whistle-blowers who worked at an Adventist hospital in Hendersonville, N.C., and one whistle-blower who worked at the system's corporate office. The whistle-blowers brought the allegations under the qui tam provision of the False Claims Act.

The Adventist settlement is the largest healthcare fraud settlement ever made involving physician referrals to hospitals. The previous largest settlement involving these types of allegations was entered into last week by North Broward Hospital District.

Although Adventist agreed to this settlement, there has been no determination of liability in this case.

More articles on healthcare industry lawsuits:

Government claims hospital owner charged Medicare for BMWs
39 recently unsealed False Claims Act case: 5 things to know
5 latest healthcare industry lawsuits, settlements

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars