Missouri healthcare facilities busted for Medicare fraud

Turned in by a whistle-blower, two Southwest Missouri health care providers that were submitting false claims to the Medicare Program agreed to settle the matter by paying the United States $34,000,000.

According to the Department of Justice, Mercy Hospital Springfield, previously known as St. John’s Regional Health Center, and its affiliate, Mercy Clinic Springfield Communities, previously known as St. John’s Clinic, have agreed to settle allegations that they violated the False Claims Act by “engaging in improper financial relationships with referring physicians.”

Federal law restricts the financial relationships that hospitals and clinics may have with doctors who refer patients to them.

“When physicians are rewarded financially for referring patients to hospitals or other health care providers, it can affect their medical judgment, resulting in overutilization of services that drives up health care costs for everyone,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division.  “In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable.”

Dr. Viran Roger Holden, a physician who was employed by one of the clinics, turned them in. Under the False Claims Act, private citizens who bring suit on behalf of the government for false claims are eligible to share in any recovery.  Dr. Holden will receive a whopping $5,440,000 from the recovery.

“Patients deserve assurances that they are receiving appropriate medical care, unbiased by hidden incentives. And taxpayers deserve assurances that the cost of public health care programs is not inflated by unnecessary procedures and services,” said Acting U.S. Attorney Thomas M. Larson for the Western District of Missouri, noting that settlements like this serve to protect patients and the public against dishonest physicians.

The False Claims Act is a powerful tool in the government’s efforts to fight healthcare fraud. Tips from all sources can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).

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