In an obscure set of facts, a Savannah-based healthcare facility recently remitted $4 million to the federal government following allegations it unlawfully re-routed patients to a facility over 90 miles away for inpatient procedures – all in the name of allegedly profiting from Medicare and Medicaid. According to the complaint, Optim is also implicated in violations of the Stark Law, which prohibits the engagement of improper financial relationships between physicians and facilities, such as arranging for volume-based pay or kickbacks.
In the case against Optim, U.S. Attorney Edward J. Tarver reminded us “[h]ealthcare is not about making as much money as possible. Programs like Medicare operate on the honesty and decency of its providers, and this office will actively pursue those who misuse the federal healthcare programs or their beneficiaries for financial gain.”
Details of the Case Against Optim Healthcare
The False Claims Act case against Optim began following an onslaught of patient complaints to government authorities about Optim’s inexplicable travel requirements for inpatient services. More specifically, patients living in the Savannah, Georgia area who were in need of major surgery, were told to appear at an Optim Healthcare hospital located in a rural area of Tattnall County, Georgia. This facility was over 90 miles away from the Savannah area and caused significant difficulties for ill or injured patients in need of a surgical procedure.
Following the various complaints initiated by frustrated patients, the government decided to take a closer look into Optim’s operating procedures, and determined that Optim’s motivation for re-routing patients to rural Tattnall County had nothing to do with patient care or comfort. Not surprisingly, the motivation was money. More specifically, the settlement addresses allegations that from 2008 through 2012, Optim submitted claims for both surgical and other medical procedures that contained a number of unlawful flaws. First, many claims were revealed to be improperly inflated beyond the actual scope of the work performed. Second, claims were wrongfully identified in order to receive a higher reimbursement rate (a practice known as “upcoding”). Lastly, Optim also engaged in unlawful physician self-referrals, which violates the federal Stark Law designed to eliminate the creation of financial incentive for patient referrals to certain facilities.
Several of the allegations against Optim also resolved a whistleblower lawsuit filed by an individual relator. The details of the whistleblower’s identity or ultimate payout have not been identified as of this time.
The U.S. Department of Health and Human Services also commented on the settlement, stating, “Today’s settlement demonstrates that the OIG will aggressively investigate all allegations made against trusted healthcare providers who misrepresent services and violate the Physician Self-Referral Statute….This kind of behavior adversely affects both patient care and healthcare costs, and will not be tolerated.”
Suspect Fraud? Speak Up
As today’s case illustrates, some corporations will go to great lengths to conspire an increased profit from Medicare and Medicaid. If the facts of this case seem familiar to you, or you are aware of a similar sort of healthcare fraud in your place of employment, please contact Berger Montague today.