Healthcare billing fraud: 5 latest settlements

Here are five healthcare organizations that entered into settlements to resolve billing fraud allegations in the past two months:

1. Wisconsin health system will pay $10M to settle whistleblower case
Agnesian HealthCare, a three-hospital system based in Fond du Lac, Wis., and its affiliated physician group agreed to pay $10 million to resolve allegations that Agnesian paid kickbacks to physicians in exchange for patient referrals. An orthopedic surgeon who worked at Agnesian filed the lawsuit in 2014 under the qui tam, or whistleblower, provisions of the False Claims Act.

2. Physician group will refund Medicare $829K to resolve improper billing case
VPA, a physician group that provides home-based care to patients in 12 states, and its management services affiliate agreed to repay the federal government $829,611, to resolve allegations that they billed Medicare for medically unnecessary physician visits.

3. Massachusetts hospital settles false billing case
Cooley Dickinson Hospital in Northampton, Mass., entered into a settlement with the federal government to resolve the allegation that it submitted claims for medically unnecessary testing to Medicare and Medicaid. The hospital, an affiliate of Boston-based Partners HealthCare, will pay $11,332 to resolve the lawsuit, which was originally filed by a patient under the whistleblower provisions of the False Claims Act.

4. Vibra Healthcare to pay $6M to settle 2016 whistleblower suit
Mechanicsburg, Pa.-based Vibra Healthcare will pay $6.25 million to resolve whistleblower allegations against Highlands Rehabilitation Hospital in El Paso, Texas. The lawsuit alleged that Highlands and others submitted false claims that did not meet Medicare requirements for reimbursement.

5. Sutter Health to settle kickback lawsuit for $30M
Sacramento, Calif.-based Sutter Health paid $30 million to settle allegations of a referral fraud scheme. The lawsuit alleged one medical group, Sacramento Cardiovascular Surgeons Medical Group, was billing for more than 40 hours per week for five weeks per month, and also billed for vacation time as if it were spent working. The group allegedly had a deal with Sutter to receive free physician assistants, whose salaries were paid for by the health system, if they referred patients within the system. It then also billed Medicare and other payers for services provided by the physician assistants.

More articles on legal and regulatory issues:
South Carolina hospital escapes suit over physician's lack of adequate insurance
Feds recovered $2.6B from healthcare fraud cases in 2019
CHS reaches $53M deal in class-action stock drop lawsuit

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