Two Ohio hospitals agreed Friday to pay the U.S. government $108 million to settle claims that the institutions violated federal law by unlawfully paying doctors for referrals of cardiac patients.
The U.S. Department of Justice (DOJ) had charged that Health Alliance of Greater Cincinnati and a former member hospital, Christ Hospital of Mount Auburn, limited the opportunity to work at their Heart Station outpatient cardiology testing unit to cardiologists who referred cardiac business to Christ Hospital.
The DOJ asserted that cardiologists whose referrals contributed at least 2% to the hospital's yearly gross revenues received a corresponding percentage of time at the Heart Station, which provides noninvasive heart procedures such as electrocardiograms, echocardiograms, and stress tests. When there, they had the opportunity to generate additional income by billing for the patients they treated at the unit and for any follow-up procedures that these patients required.
The allegations were initiated by a whistleblower lawsuit filed under the False Claims Act in 2008 by Dr. Harry Fry, a cardiologist who formerly worked at Christ Hospital. Fry will receive $23.5 million as part today's settlement.
In a written statement, Susan Croushore, president and CEO of Christ Hospital, said the facility "continues to disagree with the government's allegations that the assignment of physicians to our cardiac testing station resulted in the inducement of local cardiologists to refer patients to the hospital, [and] we decided to contribute to the joint settlement agreement with the Health Alliance of Greater Cincinnati instead of risking a potential catastrophic judgment that could jeopardize our ability to provide service to this community."
She added that the settlement allows Christ Hospital to "avoid the risk" of a judgment in excess of a $1 billion award that was sought by the federal government.
The federal antikickback statute prohibits a hospital from offering or paying, or a physician from soliciting or receiving, anything of value in return for patient referrals. The DOJ also alleged that reimbursement claims submitted by Christ Hospital to Medicare and Medicaid as a result of the Heart Station arrangement constituted a violation of the False Claims Act.
In a written statement, Tony West, assistant attorney general for the DOJ's civil division, said, "Healthcare providers should make medical decisions based on the needs of their patients, not on the financial interests of physicians or other providers. We will not allow hospitals to put profits ahead of sound medical decision-making."
According to the DOJ, the department has recovered more than $3.7 billion through the False Claims Act since January 2009.
By Wayne Forrest
AuntMinnie.com staff writer
May 21, 2010
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U.S. DOJ joins 'kickback' case against Ohio heart centers, April 2, 2008
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