St. Joseph's to Pay $22M to Settle Federal Charges
St. Joseph's is subject to exclusion from federal healthcare programs including Medicare and Medicaid if it fails to comply with the U.S. Department of Health and Human Services and Office of Inspector General corporate integrity agreement.
The agreement requires the hospital to:
- Appoint physician executives to oversee medical staff quality of care
- Hire a peer review consultant to review peer-review practices
- Hire an independent review organization to perform cardiac catheterization procedure reviews to evaluate their medical necessity.
The case was originally brought by whistleblowers, Stephen D. Lincoln, MD., Peter Horneffer, MD. and Garth McDonald, MD., cardiac surgeons who practiced as members of Cardiac Surgery Associates in Baltimore. The lawsuit, in the District of Maryland in June, contains allegations that SJMC violated the Anti-Kickback Act, Stark Law and False Claims Act by paying various forms of illegal remuneration to MACVA to induce referrals of patients insured by federal health care programs for cardiac procedures.
Under qui tam provisions of the anti-kick back statutes, the whistleblowers will receive a portion of the $22 million.
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