FROM: U.S JUSTICE DEPARTMENT
Thursday, March 13, 2014
Memorial Hospital in Ohio Pays Government $8.5 Million to Settle False Claims Act Allegations
Memorial Hospital (Memorial), an Ohio nonprofit corporation that operates an acute care hospital in Fremont, Ohio, has agreed to pay $8.5 million to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute by engaging in improper financial relationships with referring physicians, the Justice Department announced today.
“Improper financial relationships between health care providers and their referral sources can undermine physicians' judgment about patients' true health care needs and drive up health care costs for everyone,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery. "The Justice Department is firmly committed to recovering the taxpayer dollars lost due to these arrangements and making sure that all health care providers follow the rules.”
The Anti-Kickback Statute and the Stark Statute restrict the financial relationships that hospitals may have with doctors who refer patients to them. The settlement announced today involved allegations that financial relationships that Memorial had with two physicians – a joint venture between Memorial and a pain management physician and an arrangement under which an ophthalmologist purchased intraocular lenses and then resold them to Memorial at inflated prices - violated statutory requirements. These issues were disclosed to the government by Memorial.
"Physician referrals should be made exclusively based on what's best for the patient, not on financial relationships," said U.S. Attorney for the Northern District of Ohio Steven M. Dettelbach. "We hope that this settlement will once again help drive that message home."
The improper referrals at issue in this matter included Medicaid patients. Medicaid is funded jointly by the states and the federal government. The State of Ohio, which paid for some of the Medicaid claims at issue, will receive $600,383 of the settlement amount.
“The price of such arrangements can be very costly to the nation’s health care system, taxpayers and provider organizations,” said Inspector General of the U.S. Department of Health and Human Services Daniel R. Levinson. “So, we are pleased that Memorial stepped forward to disclose these improper financial relationships and is working to avoid future occurrences.”
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Secretary of Health and Human Services Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.
This case was handled by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Northern District of Ohio and the Department of Health and Human Services Office of Inspector General. The claims settled by this agreement are allegations only, and there has been no determination of liability.
Showing posts with label HOSPITALS. Show all posts
Showing posts with label HOSPITALS. Show all posts
Monday, March 17, 2014
Monday, July 8, 2013
COMPANY TO PAY $14.5 MILLION TO SETTLE OVERBILLING ALLEGATIONS
FROM: U.S. DEPARTMENT OF JUSTICE
Wednesday, July 3, 2013
Tacoma, Wash., Medical Firm to Pay $14.5 Million to Settle Overbilling Allegations
Bills Claimed Higher Level of Service Than Was Documented
Sound Inpatient Physicians Inc. will pay $14.5 million to settle allegations that it overbilled Medicare and other federal health care programs, the Justice Department announced today. Sound Physicians is a Tacoma, Wash.-based provider of hospitalists and other physicians to hospitals and other medical facilities. It employs more than 700 hospitalists and post-acute physicians, who provide services at 70 hospitals and a growing network of post-acute facilities in 22 states.
"Physicians who participate in Medicare and other federal health care programs must document and bill for their services accurately and honestly," said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division. "The Department of Justice is committed to ensuring that Medicare and other federal funds are expended appropriately."
Today’s settlement addresses allegations that, between 2004 and 2012, Sound Physicians knowingly submitted to federal health benefits programs inflated claims on behalf of its hospitalist employees for higher and more expensive levels of service than were documented by hospitalists in patient medical records. Hospitalists are physicians, typically trained in internal medicine, who provide care exclusively to hospital inpatients and have no office or outpatient practice.
"Fraudulently inflated billing of government health care programs puts those programs at risk, and impacts the system’s ability to care for the neediest in our communities," said Jenny A. Durkan, U.S. Attorney for the Western District of Washington. "During this time of tight government budgets, we will do all we can to make sure everyone plays by the rules and does not run up the taxpayers’ tab."
Allegations that Sound Physicians had improperly billed a variety of federal health care programs were brought to the government’s attention through a lawsuit filed by a former Sound Physicians employee, Craig Thomas, under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens to bring civil actions on behalf of the government and share in any recovery. Thomas will receive $2.7 million of the $14.5 million settlement for exposing Sound Physicians’ inflated claims.
This civil settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $14.7 billion through False Claims Act cases, with more than $10.7 billion of that amount recovered in cases involving fraud against federal health care programs.
The Sound Physicians settlement was the result of a coordinated effort by the Department of Justice, Civil Division, Commercial Litigation Branch; the U.S. Attorney’s Office for the Western District of Washington; the Department of Health and Human Services Office of Inspector General; the Department of Defense, Office of Inspector General, Defense Criminal Investigative Service; the Office of Personnel Management Office of Inspector General; the Department of Veterans’ Affairs Office of Inspector General; and the TRICARE Management Activity Office of General Counsel.
Wednesday, July 3, 2013
Tacoma, Wash., Medical Firm to Pay $14.5 Million to Settle Overbilling Allegations
Bills Claimed Higher Level of Service Than Was Documented
Sound Inpatient Physicians Inc. will pay $14.5 million to settle allegations that it overbilled Medicare and other federal health care programs, the Justice Department announced today. Sound Physicians is a Tacoma, Wash.-based provider of hospitalists and other physicians to hospitals and other medical facilities. It employs more than 700 hospitalists and post-acute physicians, who provide services at 70 hospitals and a growing network of post-acute facilities in 22 states.
"Physicians who participate in Medicare and other federal health care programs must document and bill for their services accurately and honestly," said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division. "The Department of Justice is committed to ensuring that Medicare and other federal funds are expended appropriately."
Today’s settlement addresses allegations that, between 2004 and 2012, Sound Physicians knowingly submitted to federal health benefits programs inflated claims on behalf of its hospitalist employees for higher and more expensive levels of service than were documented by hospitalists in patient medical records. Hospitalists are physicians, typically trained in internal medicine, who provide care exclusively to hospital inpatients and have no office or outpatient practice.
"Fraudulently inflated billing of government health care programs puts those programs at risk, and impacts the system’s ability to care for the neediest in our communities," said Jenny A. Durkan, U.S. Attorney for the Western District of Washington. "During this time of tight government budgets, we will do all we can to make sure everyone plays by the rules and does not run up the taxpayers’ tab."
Allegations that Sound Physicians had improperly billed a variety of federal health care programs were brought to the government’s attention through a lawsuit filed by a former Sound Physicians employee, Craig Thomas, under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens to bring civil actions on behalf of the government and share in any recovery. Thomas will receive $2.7 million of the $14.5 million settlement for exposing Sound Physicians’ inflated claims.
This civil settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $14.7 billion through False Claims Act cases, with more than $10.7 billion of that amount recovered in cases involving fraud against federal health care programs.
The Sound Physicians settlement was the result of a coordinated effort by the Department of Justice, Civil Division, Commercial Litigation Branch; the U.S. Attorney’s Office for the Western District of Washington; the Department of Health and Human Services Office of Inspector General; the Department of Defense, Office of Inspector General, Defense Criminal Investigative Service; the Office of Personnel Management Office of Inspector General; the Department of Veterans’ Affairs Office of Inspector General; and the TRICARE Management Activity Office of General Counsel.
Saturday, March 23, 2013
CDC SAYS NOROVIRUS LEADING CAUSE OF GASTROENTERITIS IN CHILDREN
FROM: CENTERS FOR DISEASE CONTROL AND PREVENTION
Norovirus is now the leading cause of severe gastroenteritis in US children
Norovirus is now the leading cause of acute gastroenteritis among children less than 5 years of age who seek medical care, according to a new study published in the New England Journal of Medicine. Norovirus was responsible for nearly 1 million pediatric medical care visits for 2009 and 2010 in the United States, amounting to hundreds of millions of dollars in treatment costs each year.
"Infants and young children are very susceptible to norovirus infections, which often result in a high risk of getting dehydrated from the sudden onset of intense vomiting and severe diarrhea," said Dr. Daniel Payne, an epidemiologist in the Division of Viral Diseases at the Centers for Disease Control and Prevention. "Our study estimates that 1 in 278 U.S. children will be hospitalized for norovirus illness by the time they turn 5 years of age. It is also estimated that about 1 in 14 children will visit an emergency room and 1 in 6 will receive outpatient care for norovirus infections."
The researchers tracked infants and young children requiring medical care for acute gastroenteritis, which causes inflammation of the stomach and intestines, from October 2008 through September 2010. The study looked at more than 141,000 children less than 5 years of age living in three U.S. counties. Lab testing was done to confirm specimens for norovirus.
Norovirus was detected in 21 percent (278) of the 1,295 cases of acute gastroenteritis, while rotavirus was identified in only 12 percent (152) of the cases. About 50 percent of the medical care visits due to norovirus infections were among children aged 6 to 18 months. Infants and 1-year-old children were more likely to be hospitalized than older children. However, overall rates of norovirus in emergency rooms and outpatient offices were 20 to 40 times higher than hospitalization rates. Nationally, the researchers estimated that in 2009 and 2010, there were 14,000 hospitalizations, 281,000 emergency room visits, and 627,000 outpatient visits due to norovirus illness in children less than 5 years of age. This amounted to an estimated $273 million in treatment costs each year.
"Our study confirmed that medical visits for rotavirus illness have decreased," said Dr. Payne. "Also, our study reinforces the success of the U.S. rotavirus vaccination program and also emphasize the value of specific interventions to protect against norovirus illness." Norovirus vaccines are currently being developed, which may be especially important for young children and elderly people who are high risk.
Norovirus is highly contagious. Each year, more than 21 million people in the United States get infected with norovirus and develop acute gastroenteritis, and approximately 800 people die. Young children and elderly people are more likely to suffer from severe norovirus infections. The virus spreads primarily through close contact with infected people, such as caring for someone who is ill. It also spreads through contaminated food, water and hard surfaces. The best ways to reduce the risk of norovirus infection are through proper hand washing, safe food handling, and good hygiene.
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| Credit: CDC |
Norovirus is now the leading cause of severe gastroenteritis in US children
Norovirus is now the leading cause of acute gastroenteritis among children less than 5 years of age who seek medical care, according to a new study published in the New England Journal of Medicine. Norovirus was responsible for nearly 1 million pediatric medical care visits for 2009 and 2010 in the United States, amounting to hundreds of millions of dollars in treatment costs each year.
"Infants and young children are very susceptible to norovirus infections, which often result in a high risk of getting dehydrated from the sudden onset of intense vomiting and severe diarrhea," said Dr. Daniel Payne, an epidemiologist in the Division of Viral Diseases at the Centers for Disease Control and Prevention. "Our study estimates that 1 in 278 U.S. children will be hospitalized for norovirus illness by the time they turn 5 years of age. It is also estimated that about 1 in 14 children will visit an emergency room and 1 in 6 will receive outpatient care for norovirus infections."
The researchers tracked infants and young children requiring medical care for acute gastroenteritis, which causes inflammation of the stomach and intestines, from October 2008 through September 2010. The study looked at more than 141,000 children less than 5 years of age living in three U.S. counties. Lab testing was done to confirm specimens for norovirus.
Norovirus was detected in 21 percent (278) of the 1,295 cases of acute gastroenteritis, while rotavirus was identified in only 12 percent (152) of the cases. About 50 percent of the medical care visits due to norovirus infections were among children aged 6 to 18 months. Infants and 1-year-old children were more likely to be hospitalized than older children. However, overall rates of norovirus in emergency rooms and outpatient offices were 20 to 40 times higher than hospitalization rates. Nationally, the researchers estimated that in 2009 and 2010, there were 14,000 hospitalizations, 281,000 emergency room visits, and 627,000 outpatient visits due to norovirus illness in children less than 5 years of age. This amounted to an estimated $273 million in treatment costs each year.
"Our study confirmed that medical visits for rotavirus illness have decreased," said Dr. Payne. "Also, our study reinforces the success of the U.S. rotavirus vaccination program and also emphasize the value of specific interventions to protect against norovirus illness." Norovirus vaccines are currently being developed, which may be especially important for young children and elderly people who are high risk.
Norovirus is highly contagious. Each year, more than 21 million people in the United States get infected with norovirus and develop acute gastroenteritis, and approximately 800 people die. Young children and elderly people are more likely to suffer from severe norovirus infections. The virus spreads primarily through close contact with infected people, such as caring for someone who is ill. It also spreads through contaminated food, water and hard surfaces. The best ways to reduce the risk of norovirus infection are through proper hand washing, safe food handling, and good hygiene.
Wednesday, March 6, 2013
CDC WANTS IMMEDIATE ACTION TO CURB DEADLY INFECTIONS IN HOSPITALS
FROM: CENTERS FOR DISEASE CONTROL
CDC: Action needed now to halt spread of deadly bacteria
Data show more inpatients suffering infections from bacteria resistant to all or nearly all antibiotics
A family of bacteria has become increasingly resistant to last-resort antibiotics during the past decade, and more hospitalized patients are getting lethal infections that, in some cases, are impossible to cure. The findings, published today in the Centers for Disease Control and Prevention’s
Vital Signs report, are a call to action for the entire health care community to work urgently – individually, regionally and nationally – to protect patients. During just the first half of 2012, almost 200 hospitals and long-term acute care facilities treated at least one patient infected with these bacteria.
The bacteria, Carbapenem-Resistant Enterobacteriaceae (CRE), kill up to half of patients who get bloodstream infections from them. In addition to spreading among patients, often on the hands of health care personnel, CRE bacteria can transfer their resistance to other bacteria within their family. This type of spread can create additional life-threatening infections for patients in hospitals and potentially for otherwise healthy people. Currently, almost all CRE infections occur in people receiving significant medical care in hospitals, long-term acute care facilities, or nursing homes.
"CRE are nightmare bacteria. Our strongest antibiotics don’t work and patients are left with potentially untreatable infections," said CDC Director Tom Frieden, M.D., M.P.H. "Doctors, hospital leaders, and public health, must work together now to implement CDC’s "detect and protect" strategy and stop these infections from spreading."
Enterobacteriaceae are a family of more than 70 bacteria including Klebsiella pneumoniae and E. coli that normally live in the digestive system. Over time, some of these bacteria have become resistant to a group of antibiotics known as carbapenems, often referred to as last-resort antibiotics. During the last decade, CDC has tracked one type of CRE from a single health care facility to health care facilities in at least 42 states. In some medical facilities, these bacteria already pose a routine challenge to health care professionals.
The Vital Signs report describes that although CRE bacteria are not yet common nationally, the percentage of Enterobacteriaceae that are CRE increased by fourfold in the past decade. One type of CRE, a resistant form of Klebsiella pneumoniae, has shown a sevenfold increase in the last decade. In the U.S., northeastern states report the most cases of CRE.
According to the report, during the first half of 2012, four percent of hospitals treated a patient with a CRE infection. About 18 percent of long-term acute care facilities treated a patient with a CRE infection during that time.
In 2012, CDC released a concise, practical CRE prevention toolkit with in-depth recommendations for hospitals, long-term acute care facilities, nursing homes and health departments. Key recommendations include:
enforcing use of infection control precautions (standard and contact precautions)
grouping patients with CRE together
dedicating staff, rooms and equipment to the care of patients with CRE, whenever possible
having facilities alert each other when patients with CRE transfer back and forth
asking patients whether they have recently received care somewhere else (including another country)
using antibiotics wisely
In addition, CDC recommends screening patients in certain scenarios to determine if they are carrying CRE. Because of the way CRE can be carried by patients from one health care setting to another, facilities are encouraged to work together regionally to implement CRE prevention programs.
These core prevention measures are critical and can significantly reduce the problem today and for the future. In addition, continued investment into research and technology, such as a testing approach called Advanced Molecular Detection (AMD), is critical to further prevent and more quickly identify CRE.
In some parts of the world, CRE appear to be more common, and evidence shows they can be controlled. Israel recently employed a coordinated effort in its 27 hospitals and dropped CRE rates by more than 70 percent. Several facilities and states in the U.S. have also seen similar reductions.
"We have seen in outbreak after outbreak that when facilities and regions follow CDC’s prevention guidelines, CRE can be controlled and even stopped," said Michael Bell, M.D., acting director of CDC’s Division of Healthcare Quality Promotion. "As trusted health care providers, it is our responsibility to prevent further spread of these deadly bacteria."
CDC: Action needed now to halt spread of deadly bacteria
Data show more inpatients suffering infections from bacteria resistant to all or nearly all antibiotics
A family of bacteria has become increasingly resistant to last-resort antibiotics during the past decade, and more hospitalized patients are getting lethal infections that, in some cases, are impossible to cure. The findings, published today in the Centers for Disease Control and Prevention’s
Vital Signs report, are a call to action for the entire health care community to work urgently – individually, regionally and nationally – to protect patients. During just the first half of 2012, almost 200 hospitals and long-term acute care facilities treated at least one patient infected with these bacteria.
The bacteria, Carbapenem-Resistant Enterobacteriaceae (CRE), kill up to half of patients who get bloodstream infections from them. In addition to spreading among patients, often on the hands of health care personnel, CRE bacteria can transfer their resistance to other bacteria within their family. This type of spread can create additional life-threatening infections for patients in hospitals and potentially for otherwise healthy people. Currently, almost all CRE infections occur in people receiving significant medical care in hospitals, long-term acute care facilities, or nursing homes.
"CRE are nightmare bacteria. Our strongest antibiotics don’t work and patients are left with potentially untreatable infections," said CDC Director Tom Frieden, M.D., M.P.H. "Doctors, hospital leaders, and public health, must work together now to implement CDC’s "detect and protect" strategy and stop these infections from spreading."
Enterobacteriaceae are a family of more than 70 bacteria including Klebsiella pneumoniae and E. coli that normally live in the digestive system. Over time, some of these bacteria have become resistant to a group of antibiotics known as carbapenems, often referred to as last-resort antibiotics. During the last decade, CDC has tracked one type of CRE from a single health care facility to health care facilities in at least 42 states. In some medical facilities, these bacteria already pose a routine challenge to health care professionals.
The Vital Signs report describes that although CRE bacteria are not yet common nationally, the percentage of Enterobacteriaceae that are CRE increased by fourfold in the past decade. One type of CRE, a resistant form of Klebsiella pneumoniae, has shown a sevenfold increase in the last decade. In the U.S., northeastern states report the most cases of CRE.
According to the report, during the first half of 2012, four percent of hospitals treated a patient with a CRE infection. About 18 percent of long-term acute care facilities treated a patient with a CRE infection during that time.
In 2012, CDC released a concise, practical CRE prevention toolkit with in-depth recommendations for hospitals, long-term acute care facilities, nursing homes and health departments. Key recommendations include:
grouping patients with CRE together
dedicating staff, rooms and equipment to the care of patients with CRE, whenever possible
having facilities alert each other when patients with CRE transfer back and forth
asking patients whether they have recently received care somewhere else (including another country)
using antibiotics wisely
In addition, CDC recommends screening patients in certain scenarios to determine if they are carrying CRE. Because of the way CRE can be carried by patients from one health care setting to another, facilities are encouraged to work together regionally to implement CRE prevention programs.
These core prevention measures are critical and can significantly reduce the problem today and for the future. In addition, continued investment into research and technology, such as a testing approach called Advanced Molecular Detection (AMD), is critical to further prevent and more quickly identify CRE.
In some parts of the world, CRE appear to be more common, and evidence shows they can be controlled. Israel recently employed a coordinated effort in its 27 hospitals and dropped CRE rates by more than 70 percent. Several facilities and states in the U.S. have also seen similar reductions.
"We have seen in outbreak after outbreak that when facilities and regions follow CDC’s prevention guidelines, CRE can be controlled and even stopped," said Michael Bell, M.D., acting director of CDC’s Division of Healthcare Quality Promotion. "As trusted health care providers, it is our responsibility to prevent further spread of these deadly bacteria."
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