Louisville, Ky.-based Jewish Hospital & St. Mary's Healthcare will pay $10.1 million to settle claims that its in-house pharmacy knowingly submitted false claims to Medicare for drugs that didn't meet coverage requirements, the U.S. Justice Department said.
Prosecutors said that the hospital pharmacy failed to obtain the treating physician's signature on the order to establish medical necessity, failed to confirm refills were needed and didn't document that the medications were delivered.
"Healthcare providers will be held accountable when they knowingly submit false claims for prescription drugs that do not meet requirements to establish medical necessity," said Jody Hunt, assistant attorney general in the Justice Department's civil division.
The settlement also resolves allegations that the hospital violated the federal Anti-Kickback Statute by submitting claims to Medicare that resulted in improper payments to Medicare beneficiaries in the form of free supplies for blood glucose testing and waiver of copays and deductibles for insulin.
The whistleblower allegations were originally brought by Robert Stone, a former pharmacist at the hospital.
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