In January 2015, two parent companies of the Pennsylvania-based Easton Hospital agreed to pay $662,000 to settle claims of false billing and unlawful practices involving Medicare and Medicaid patients. Northampton Hospital Co. LLC and Northampton Hospital Corp. agreed to the settlement following the filing of a formal complaint under the False Claims Act by two former employees of Easton Hospital. The relators are expected to split a $120,000 reward in exchange for their willingness to come forward with allegations of fraud and false billing. Under the False Claims Act’s qui tam provisions, a whistleblower (also known as a relator) can recover up to 30 percent of the total amount recovered by the government.
Details of case against Easton Hospital
The details of the allegations against Easton Hospital pertain to its urology department and the consistent performance of medically unnecessary procedures by urologist Thomas Walden. More specifically, Walden is alleged to have performed procedures including shock wave lithotripsy, cystometrogram, green light laser, and transurethral resection of the prostate on Medicare patients who were not in need of such invasive, costly procedures. Beginning in 2007, the urologist was allegedly recommending these procedures to patients who could have benefitted from a less costly treatment option. Moreover, the allegations also reveal that Walden was submitting bills to Medicare for these procedures despite having never performed such operations on actual patients.
On the heels of a record-breaking year in terms of healthcare fraud settlements and recoveries, the federal government continues to forge ahead in eliminating this dangerous and wasteful form of abuse of taxpayer dollars. According to the U.S. Attorney’s Office, “The United States Attorney’s Office for the Eastern District of Pennsylvania places a high priority on criminal and civil enforcement in cases involving health care fraud….Health care fraud wastes tax dollars, harms patients, and drives up medical costs for everyone. We encourage our citizens to report potential health care fraud so that we can effectively investigate and prosecute this type of wrongdoing.”
An Easton Hospital spokesperson said in a statement, “We are pleased to have reached this settlement with the U.S. Department of Justice and have cooperated fully in the investigation.…Easton Hospital has a robust compliance program and is committed to providing our patients with quality care. As part of our compliance program, we voluntarily repaid certain Medicare claims prior to the government’s investigation. The physician who was responsible for the claims resolved in this settlement has not been affiliated with Easton Hospital since June 2010.”
The whistleblowers in the case were both well-affiliated with the hospital, having worked as a director of surgical services and a hospital systems analyst.
Dr. Walden, who was not a party to the settlement, has escaped criminal liability under the terms of the agreement. However, the nature of any civil liability facing the physician has not been publicly disclosed at this time.
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