Federal prosecutors allege that between 2003 and 2013, Columbus Regional Healthcare System "provided excessive salary and directorship payments to an oncologist affiliated with the hospital in a financial arrangement that violated the Stark Law."
A Georgia hospital will have to pay upwards of $35 million to resolve allegations of False Claims Act violations involving self-referrals and overcharging for care, federal prosecutors say.
Columbus Regional Healthcare System has agreed to pay $25 million, plus additional contingent payments not to exceed $10 million, for a maximum settlement amount of $35 million. Andrew Pippas, MD, a Columbus-based hematologist/oncologist affiliated with the hospital, has agreed to pay $425,000 for his alleged role in the infractions, according to Michael Moore, U.S. Attorney for the Middle District of Georgia.
Federal prosecutors allege that between 2003 and 2013, Columbus Regional "provided excessive salary and directorship payments to Pippas that violated the Stark Law," which prohibits certain physician referrals for Medicare and Medicaid patients if the physician and the referring entity have a financial relationship.
Prosecutors also allege that from May 2006 through May 2013, Columbus Regional overbilled Medicare and Medicaid for services at higher levels than supported by the documentation, and between 2010 and 2012, they overbilled for radiation therapy at higher levels than the therapy that was provided.
Columbus Regional and Pippas will pay $24.6 million to the federal government for federal healthcare program losses and $759,000 to the state of Georgia for the state share of its Medicaid losses.
"Now that we have these matters behind us, I am looking forward with renewed energy to continuing to advance and improve the cancer care we deliver at the John B. Amos Cancer Center," said Pippas, in a statement issued by Columbus Regional. As of Tuesday evening, Pippas was listed on the leadership page of the Georgia Society of Clinical Oncology.
"The maximum amount of this settlement, some $35 million, is appropriate given the number of alleged violations involving the False Claims Act and the Stark Act," Moore said in prepared remarks.
"Access to healthcare is on everyone's mind, especially with respect to rural communities. The type of conduct alleged in this case puts that access at risk," Moore said. "This settlement reflects on the one hand, the Department of Justice's commitment to make sure that hospitals and physicians who commit violations of federal law are held to account, and on the other hand, especially with the requirement of the monitoring agreement, makes sure that we continue to have appropriately functioning healthcare providers accessible to the wide array of communities they serve."
'Not an Admission of Liability'
Columbus Regional issued a statement announcing the $35 million settlement, but noted that it "is not an admission of liability. The parties agreed to settle in order to avoid continued costly and protracted litigation."
"We are glad to put these issues behind us and focus 100% of our energies on continuing to deliver quality patient care and service at all of our entities," Columbus Regional CEO and President Scott Hill said in a statement released by his office.
Columbus Regional will enter into a five-year corporate integrity agreement with the Department of Health and Human Services, Office of the Inspector General.
The settlements resolve allegations filed in two lawsuits by Richard Barker, a former Columbus Regional executive. The lawsuits were filed under the whistleblowerprovisions of the False Claims Act and the Georgia False Medicaid Claims Act. Barker's share of the settlement has not yet been determined.
Since January 2009, the Justice Department has recovered a total of more than $24.9 billion through False Claims Act cases, with more than $15.9 billion of that amount recovered in cases involving fraud against federal healthcare programs, prosecutors said.
John Commins is the news editor for HealthLeaders.