Health Alliance of Greater Cincinnati, Two Ohio Hospitals, and Physician Group to Pay $2.6 Million to Resolve Fraud Allegations

June 25th, 2010 by Qui Tam

The Health Alliance of Greater Cincinnati, two of its member hospitals (The Fort Hamilton Hospital and The University Hospital), and University Internal Medicine Associates Inc. have agreed to pay the United States $2.6 million to settle claims that they violated the Anti-Kickback Statute and the False Claims Act by engaging in a kickback-for-referral scheme, announced the United States Department of  Justice.

The Fort Hamilton Hospital is a 310-bed hospital located in Hamilton, Ohio. The alleged scheme involved the hospital’s desire to expand the scope of its cardiology services to include certain interventional cardiology procedures. Under state law, The Fort Hamilton Hospital could only perform the interventional cardiology procedures if it participated in a particular clinical trial involving those procedures.

The government asserted that University Internal Medicine Associates, a physician group based at The University Hospital in Cincinnati, offered to provide the interventional cardiology coverage that The Fort Hamilton Hospital needed for the clinical trial, but only if the hospital agreed to refer cardiology patients and procedures to the physician group on a preferential basis. The government contended that the preferential referral arrangements sometimes resulted in patients being transferred to The University Hospital, or being seen by cardiologists with University Internal Medicine Associates, rather than the hospital or cardiologist of their choosing.

The government asserted that the arrangements violated the federal Anti-Kickback Statute, which prohibits a hospital from soliciting or receiving, or a physician from offering or paying, anything of value in return for patient referrals. Violations of the federal Anti-Kickback Statute, 42 U.S.C. Section 1320a-7b(b), have served as the basis for many whistleblower (or “Qui Tam”)  cases under the federal False Claims Act.  The Anti-Kickback Statute, and a number of similar State laws, generally prohibit anyone from offering, paying, soliciting or receiving any remuneration to induce (or reward) a referral of a person for services or items paid for by Medicare, Medicaid, another federal healthcare program.  These improper payments can come in many different forms, including, but not limited to: referral fees; finder’s fees; productivity bonuses; discounted leases; discounted equipment rentals; research grants; speaker’s fees; excessive compensation; and free or discounted travel or entertainment.

The allegations resolved by the settlement were initiated by a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act, which allow private parties to file actions on behalf of the United States and share in any recovery. The whistleblower in this suit, Dr. Deborah Hauger, a cardiologist who formerly worked at The Fort Hamilton Hospital, will receive $468,000.

For more information go to http://www.justice.gov/opa/pr/2010/June/10-civ-696.html

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