St. John’s Health System, headquartered in Tulsa, Oklahoma, has agreed to pay the United States $13,229,348.88 to settle allegations that it submitted claims to Medicare and Medicaid that were tainted by the hospital’s financial relationships with referring physicians.
Federal law prohibits health care providers like St. John’s from billing the federal healthcare program for referrals from doctors with whom the providers have a financial relationship, unless the relationship falls within certain exceptions. Additionally, the Anti-Kickback Statute prohibits the payment of kickbacks for the referral of services that are paid for under a federal healthcare program. In this case, St. John’s made payments to twenty-three individual physician or physician groups to induce referrals for medical services.
This case did not arise from a whistleblower. Instead, this information was discovered in April of 2008 when St. John’s submitted a self-disclosure report to the Department of Health and Human Services Office of Inspector General where they acknowledged that the physician agreements may have run afoul of federal law.
The Department of Justice press release can be found at: http://www.justice.gov/opa/pr/2009/December/09-civ-1376.html