The Columbus Regional Health System, which maintains several hospitals, clinics, and a retirement community in the Columbus, Georgia area, has agreed to pay $35 million to settle allegations that it offered lucrative kickbacks and incentives to physicians in violation of the False Claims Act and Stark Law. Both laws prohibit the unlawful “taint” of financial gain within the doctor-patient relationship, and work to punish and deter specialists and physicians who seek to gain financially from a certain referral.
The group is also alleged to have upcoded for patient services in excess of what was actually offered–an all-too-common practice within the modern healthcare landscape.
The case was brought to light by a former executive for the Columbus Regional Health System. The amount of his qui tam reward has not been disclosed, but it is not uncommon for whistleblowers to receive up to 30 percent of the final settlement amount–up to $10.5 million in this case.
The allegations against Columbus Regional
The allegations against Columbus Regional are two-fold, involving both illegal kickbacks and unlawful billing procedures. In the first part, the company is alleged to have offered doctors both bonuses and “directorship payments” directly related to the number of Medicaid and Medicare referrals sent to the Columbus Regional system. In the second, the company is accused of upcoding Medicare and Medicaid for unnecessary medical services.
Many of the allegations focused specifically on the John B. Amos Cancer Center, as well as its medical director Dr. Andrew Pippas.[1. Lisa Schencker, “Georgia system to pay up to $35M in settlement with feds,” Modern Healthcare, September 4, 2015, http://www.modernhealthcare.com/article/20150904/NEWS/150909927] Pippas was allegedly highly integral in setting up the illegal kickback arrangements between area oncologists and the Center. Pippas is also alleged to have upcoded Medicare and Medicaid for radiation services in excess of that which was actually performed. Pippas agreed to personally pay $425,000 to settle the unlawful billing allegations raised against him, stating, “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.”
Columbus Regional stated that it has put significant energy into government compliance, and agreed to enter into a corporate integrity agreement as well as to “engage in a thorough review process to ensure accurate billing and coding and proper compensation in physician relationships.”
The U.S. Attorney’s Office for the Middle District of Georgia commented on the matter, stating that, “Access to health care is on everyone’s mind, especially with respect to rural communities….The type of conduct alleged in this case puts that access at risk. The settlement, on the one hand, reflects 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 we continue to have the appropriately functioning health care providers accessible to the wide array of the communities they serve.”[2. Chuck Williams, “Columbus Regional to pay up to $35 million to end whistleblower lawsuit,” Ledger Enquirer, September 4, 2015, http://www.ledger-enquirer.com/news/business/health-care/article34044897.html.]
Contact Berger Montague today
If you are concerned about possible billing issues within your place of employment, or would like to speak to a confidential whistleblower attorney about fraud against the state or federal government, please contact Berger Montague today.