Ascension Michigan to Pay $2.8M to Settle False Claims Allegations

Four Michigan hospitals were named in the suit, which stems from the questionable practices of one gynecologic oncologist.

Ascension Michigan will pay $2.8 million to settle whistleblower False Claims Act allegations that four of its hospitals filed claims for medically unnecessary procedures performed over more than six years by a gynecologic oncologist, the Department of Justice said.

According to federal prosecutors, from Feb. 1, 2011, through June 30, 2017, Ascension Michigan knowingly falsely billed Medicare and other federal government healthcare programs and improperly kept payments for professional and facility fees related to medically unnecessary radical hysterectomies that "the Doctor" – not named by DOJ -- performed, including chemotherapies that the doctor administered, and evaluations and management services by the doctor that were not performed or misrepresented.

The federal complaint notes that the doctor's higher-than-average rates of pulmonary embolisms and surgical infections, and patients' complaints, aroused the suspicions of Ascension Michigan managers. They hired an independent doctor to conduct a peer review that found that, for most of the radical hysterectomies and chemotherapy performed by the doctor, a less aggressive surgery or medical intervention would have been the care standard.

In June 2018, Ascension self-disclosed the fees it billed to federal healthcare programs for services provided by the doctor. Though the health system at first improperly kept the money, it cooperated in the DOJ investigation and "took active steps" to address concerns raised about the doctor, including the peer review, placing the doctor on a performance improvement plan, and canceling its contract with the doctor.

"When hospitals receive payment from federal healthcare programs for medically unnecessary surgical procedures, they cannot simply retain those payments; they have an obligation to return them," DOJ's Civil Division Acting Assistant Attorney General Brian M. Boynton said. "We will continue to ensure that taxpayer funds are used appropriately for the important programs that they support."

The four Michigan hospitals named in the settlement are: Providence Park Hospital; St. John Hospital and Medical Center; St. John Macomb Oakland Hospital; and Ascension Crittenton Hospital.

Ascension Michigan did not respond to HealthLeaders' request for comment on the settlement.