The settlement resolves allegations that the hospital knowingly submitted false claims to Medicare for drugs that did not meet coverage requirements.
Louisville's Jewish Hospital & St. Mary's Healthcare Inc. will pay the federal government $10.1 million to settle whistleblower allegations that it knowingly submitted false claims to Medicare for drugs that did not meet coverage requirements, the Department of Justice.
The federal complaint also alleged that Jewish Hospital failed to get a treating physician's signature on prescription orders establishing medical necessity, failed to confirm that refills were reasonable and necessary, and failed to document that the medications were delivered.
The settlement also resolves allegations that Jewish Hospital submitted claims to Medicare that led to improper payments to Medicare beneficiaries in the form of free blood glucose testing supplies and waiver of co-payments and deductibles for insulin, all violations of the Anti-Kickback Statute, DOJ said.
Attempts Wednesday to contact Jewish Hospital & St. Mary's Healthcare, Inc. for comment were not successful.
"Healthcare providers will be held accountable when then knowingly submit false claims for prescription drugs that do not meet requirements to establish medical necessity," said Assistant Attorney General Jody Hunt of the Department of Justice's Civil Division.
The settlement resolves allegations originally brought in a whistleblower lawsuit filed by Robert Stone, a pharmacist, who will receive $1.85 million of the settlement.
“Healthcare providers will be held accountable when then knowingly submit false claims for prescription drugs that do not meet requirements to establish medical necessity. ”
Assistant Attorney General Jody Hunt, DOJ, Civil Division
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
Photo credit: Mark Van Scyoc / Shutterstock.com
KEY TAKEAWAYS
The federal complaint alleged that Jewish Hospital failed to get a treating physician's signature on prescription orders establishing medical necessity, failed to confirm that refills were reasonable and necessary, and failed to document that the medications were delivered.
The settlement also resolves allegations that Jewish Hospital submitted claims to Medicare that led to improper payments to Medicare beneficiaries in the form of free blood glucose testing supplies and waiver of co-payments and deductibles for insulin, all violations of the Anti-Kickback Statute.