Ascension Michigan to pay $ 2.8 million, resolving whistleblower claims of unnecessary proceedings

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A Michigan-based hospital system agreed to pay $ 2.8 million to resolve allegations by whistleblowers that they submitted false statements for allegedly unnecessary procedures. The hospital group, consisting of St. John Hospital and Medical Center, Providence Park Hospital, St. John Macomb Oakland Hospital and Ascension Crittenton Hospital (collectively, Ascension Michigan), agreed to pay in order to resolve claims that one of their gynecologist oncologists (known here as the Doctor) routinely performed operations that exceeded the standard of care. According to an August 5 press release from the US Department of Justice, the doctor performed medically unnecessary radical hysterectomies, then failed to reimburse the money the government paid for patients covered by health care programs. federal authorities for operations to be carried out.

The press release alleges that between 2011 and 2017, Ascension Michigan knowingly submitted false claims to federal medical programs and withheld money that should have been returned to the programs because the procedures on which the claims were based were unnecessary . The false allegations that Ascension Michigan allegedly submitted included the hysterectomies, but also contained claims for chemotherapy services the doctor administered or ordered that were not medically necessary, and services that were assessed and managed by the doctor. which have not been made or rendered as shown.

Ascension Michigan reportedly realized the doctor had higher than average complication rates resulting from the procedures, as well as higher than normal patient complaints. Ascension Michigan reportedly hired a third-party physician to peer review a sample of the physicians’ patients. This third-party physician concluded that many patients could have had surgery less invasive or aggressive than the operation the physician actually performed on them. The doctor was then placed on a performance improvement plan and later released by the medical company. Ascension Michigan also made a supplier self-disclosure protocol submission to the Office of the Inspector General of the US Department of Health and Human Services (HHS-OIG) in June 2018, disclosing and calling attention on claims and charges that the medical company had submitted to federal medical programs on behalf of the doctor. The press release notes that Ascension Michigan cooperated with the government investigation.

When hospitals receive payments from federal health care programs for medically unnecessary surgeries, they cannot simply keep those payments; they have an obligation to return them, said Acting Deputy Attorney General Brian M. Boynton of the Civil Division of the Department of Justice. We will continue to ensure that taxpayer funds are used appropriately for the important programs they support.

The whistleblowers in the case, Pamela Satchwell, Dawn Kasdorf and Bethany Silva-Gomez, have filed a complaint under the qui tam provisions of the False Claims Act. This makes them eligible for a stake of 15-30% of the total money collected by the government. For their part in exposing these alleged violations of the False Claims Act, the three whistleblowers will also share a reward of $ 532,000.

Read the DOJ press release here.

Read more False Claims Act / qui tam news on WNN.

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