CMC claims no liability for the whistleblower allegations.
Catholic Medical Center will pay $3.8 million to resolve whistleblower allegations that it violated the Anti-Kickback Statute when the Manchester, New Hampshire-based hospital provided free call coverage services to a cardiologist in exchange for patient referrals, the Department of Justice said.
CMC claimed no liability, but said it settled with DOJ to avoid costly litigation.
The settlement agreement with DOJ stated that CMC "paid its own cardiologists to cover for, and to be available to provide medical services for, another cardiologist’s patients when she was on vacation or otherwise unavailable."
"The United States further alleged that CMC provided these call coverage services at no charge," DOJ said. "The cardiologist who received the free call coverage referred millions of dollars in medical procedures and services to CMC over the decade in which the free services were provided."
Because CMC submitted to Medicare, Medicaid and other federal payers claims for services provided by the cardiologist's referrals, DOJ said the payments were unlawful kickbacks.
"When patients are referred for medical services, those referrals should be based solely on medical need and not affected by financial considerations," New Hampshire U.S. Attorney John J. Farley said in a media release.
"We work closely with our law enforcement partners to protect the integrity of federal health care programs and we will use all appropriate enforcement tools to combat healthcare fraud in New Hampshire."
The settlement resolves allegations originally brought in a lawsuit filed by a whistleblower, David Goldberg, MD, a former CMC employee.
CMC Responds
Lauren Collins-Cline, communications director at CMC, said the settlement involves a call coverage arrangement that began 15 years ago "with the input of legal counsel in order to provide high quality care for patients. It is no longer in place."
"While CMC vigorously disagrees with the government's allegations that this arrangement violated federal law, we have agreed to settle in order to avoid long costly civil litigation. CMC holds itself to the highest ethical standards in patient care and business conduct. That’s embedded in our mission and will always remain our highest priority," Collins-Cline said.
“While CMC vigorously disagrees with the government's allegations that this arrangement violated federal law, we have agreed to settle in order to avoid long costly civil litigation.”
Lauren Collins-Cline, communications director, CMC
John Commins is the news editor for HealthLeaders.
KEY TAKEAWAYS
DOJ said CMC "paid its own cardiologists to cover for, and to be available to provide medical services for, another cardiologist’s patients when she was on vacation or otherwise unavailable."
Because CMC submitted to Medicare, Medicaid and other federal payers claims for services provided by the cardiologist's referrals, DOJ said the payments were unlawful kickbacks.
The settlement resolves allegations originally brought in a lawsuit filed by a whistleblower, David Goldberg, MD, a former CMC employee.