A False Claims Act lawsuit was recently filed against an Ohio Hospital Operator, who agreed to pay $14.25 million to settle the allegations. The False Claims Act lawsuit alleges the hospital operator had paid improper financial kickbacks to physicians, so that they would refer patients to their facilities.

The nonprofit organization hospital operator in question is Mercy Health, which also operates facilities in Kentucky. According to the Department of Justice, the $14,250,00 settlement will resolve any wrongdoings alleged in the False Claims Act lawsuit, which primarily pertained to creating improper financial relationships with physicians to gain more patients.

More specifically, the False Claims Act lawsuit settlement will resolve the claims that the hospital operator allegedly made improper payments to six employer physicians, including one oncologist and five internal medicine doctors.

Overview of False Claims Act Lawsuit Allegations

With the alleged kickbacks, the DOJ claims these doctors were paid well above the free market rate. These payments allegedly violated federal policy in regards to financial arrangements between hospitals and physicians, as well as how doctors legally refer patients.

According to the policies made by federal law, hospitals should employ their physicians at a pay rate that is consistent with the fair market value based on the area of medicine they practice. In addition, hospitals are discouraged and can potentially face trouble for providing any other extra kickbacks for patient referrals when it may not be the best interest of the patient.

“When physicians are rewarded financially for referring patients to hospitals or other health care providers, it can affect their medical judgment, resulting in overutilization of services and higher health care costs,” said Acting Assistant Attorney of the Justice Department’s Civil Division.

This issue was brought to light by a whistleblower from Mercy Health, who reported the allegedly illegal financial arrangement to the federal government.

This False Claims Act lawsuit was handled by several different federal officials including the Justice Department’s Civil Division, the United States Attorney’s Office for the Southern District of Ohio, and the Centers for Medicare and Medicaid Services.

In exchange for paying the large False Claims Act lawsuit settlement, the claims made in the lawsuit remain allegations with no proven liability. The federal attorneys involved in this False Claims Act lawsuit says they are pleased with the outcome, having recovered millions of taxpayer dollars and increased the chances of deterring similar schemes.

Healthcare Billing Fraud

Healthcare billing fraud is one of the most prominent concerns to the federal government and the millions of taxpayers in the United States, especially in regards to Medicare, Medicaid, and other government healthcare programs.

One of the most common forms of this is when healthcare facilities, providers, or professionals bill the federal government for medications or treatments that are either unnecessary or not received by patients.

Other forms of healthcare fraud were described in this False Claims Act lawsuit, in the form of illegal financial kickback arrangements between healthcare facilities and doctors. These actions are not only detrimental to the patients primarily affected, but to the millions of taxpayers who pay in to the government every year.

Whistleblowers, or people who report this fraud, are encouraged to report their companies, fellow employees, or other individuals that may be ripping off the federal government. In exchange for their assistance, whistleblowers can expect to receive 15 to 30 percent of any money recovered from a False Claims Act lawsuit.