STARK LAW SETTLEMENT/VERDICT DATABASE

STARK LAW SETTLEMENT/VERDICT DATABASE

Date

Defendant

Jurisdiction

Amount

Description

Type1

Misc. Notes

9/27/16 7/28/16

Ralph J. Cox, III

South Carolina

Lexington County Health

Services District

South Carolina

$1,000,000 $17,000,000

Ralph J. Cox III, the former CEO of Tuomey Healthcare System, settled allegations relating to his involvement in Tuomey's illegal Medicare and Medicaid billings for services referred by physicians with whom the hospital had improper financial relationships. Cox will also be excluded for four years from participating in federal health care programs, including providing management or administrative services paid for by federal health care programs. The government alleged that Cox, fearing that Tuomey could lose lucrative outpatient procedure referrals to a new freestanding surgery center, caused Tuomey to enter into contracts with 19 specialist physicians that required the physicians to refer their outpatient procedures to Tuomey and, in exchange, paid them compensation that far exceeded fair market value and included part of the money Tuomey received from Medicare for the referred procedures, in violation of the Stark Law. The claims resolved by the settlement with Cox are allegations only, and there has been no determination of his individual liability. Lexington County Health Services District Inc. dba Lexington Medical Center (LMC) resolved allegations that it violated the Stark Law and False Claims Act by maintaining improper financial arrangements with 28 physicians. The alleged conduct involved LMC entering into asset purchase agreements for the acquisition of physician practices or employment agreements, which took into account the volume or value of physician referrals, that were not commercially reasonable or provided

Settlement Settlement

See also 10/16/15 Judgment and 5/8/13

Verdict.

1 When CMS provided summaries of self-referral disclosure protocol ("SRDP") settlements, we included such information herein. However, it appears starting in 2014 CMS no longer publishes SRDP settlements on an individual basis, but rather reports the aggregate SRDP settlements by year, at the following website: .

-1-

Date

Defendant

Jurisdiction

Amount

Description

Type1

Misc. Notes

6/1/16

Dr. Johnathon Oppenheimer (OURLab), OPKO Health, Inc. and OPKO

Lab, LLC

Tennessee

3/2/16

Mark Conklin

Florida

$9,350,000 $1,750,000

compensation in excess of FMV. LMC also entered into a CIA with the OIG which required LMC to implement measures to avoid or promptly detect similar future conduct. The claims settled by this agreement are allegations only, and there has been no determination of liability. Dr. Johnathon Oppenheimer (OURLab), OPKO Health, Inc., and OPKO Lab, LLC settled alleged violations of the False Claims Act, Anti-Kickback Statute, and Stark Law. The allegations were that OURLab and Oppenheimer made monetary contributions toward EHR systems obtained by their client physician practices, and, in making these contributions, they violated the AKS EHR safe harbor and the Stark EHR exception by, among other things, (1) directly considering the volume and/or value of referrals and business, including return on investment, between OURLab and the physicians' practice when determining whether to make an EHR donation and the amount of the donation, (2) improperly considering the volume of Medicare business supplied by the physician practice when considering an EHR donation, and (3) occasionally withholding previously agreed-upon EHR donation payments until they received a certain number of referrals from the physicians' practice. These actions placed OURLab and Oppenheimer outside of the scope of the EHR safe harbor provisions for the AKS and Stark and constituted illegal kickbacks and physician remuneration. Oppenheimer also agreed to an exclusion from participation in all federal health care programs for 5 years. The claims settled by this agreement are allegations only, and there has been no determination of liability. Mark Conklin, the former owner, operator, and sole shareholder of Recovery Home Care (RHC), settled allegations that he violated the False Claims Act, Anti-Kickback Statute, and Stark Law. The alleged

Settlement Settlement

See 3/9/15 settlement with RHC.

-2-

Date

Defendant

Jurisdiction

Amount

Description

Type1

1/29/16

Rose Radiology Centers Inc.

Florida

1/15/16

Tri-City Medical Center

California

$8,710,000 $3,278,464

conduct was RHC paid dozens of physicians thousands of dollars per month to serve as sham medical directors, who supposedly conducted quality reviews of RHC patient charts, but that the physicians performed little or no work. The claims resolved by the settlement are allegations only, and there has been no determination of liability. Rose Radiology Centers Inc. settled allegations that it violated the False Claims Act, Anti-Kickback Statute, and Stark Law. Among other conduct, the settlement resolves claims that Rose Radiology provided key referral sources financial incentives in the forms of lunches, gift cards, and tickets to concerts or sporting events in exchange for receiving business from these physicians. The claims resolved by the settlement are allegations only, and there has been no determination of liability. Tri-City Medical Center resolved allegations that it violated the Stark Law and False Claims Act by maintaining improper financial arrangements with community-based physicians and physician groups. The hospital identified five arrangements with its former chief of staff from 2008 until 2011 that, in the aggregate, appeared not to be commercially reasonable or for fair market value. The hospital also identified 92 financial arrangements with community-based physicians and practice groups that did not satisfy an exception to the Stark Law from 2009 until 2010 because, among other things, the written agreements were expired, missing signatures, or could not be located. The claims settled by this agreement are allegations only, and there has been no determination of liability.

Settlement Settlement

Misc. Notes

-3-

Date

Defendant

Jurisdiction

Amount

Description

Type1

Misc. Notes

12/23/15 10/19/15 10/16/15 10/1/15

Memorial Health, Inc.

Georgia

Millennium Health

Massach.

Tuomey Healthcare

System

South Carolina

Nurses' Registry and the

Estate of deceased Lennie House

Kentucky

$9,895,043.04 $256,000,000 $72,400,000 $16,000,000

Memorial Health, Inc., Memorial Health University Medical Center, Inc., Provident Health Services, Inc., and MPPG, Inc. resolved allegations that they violated the False Claims Act by submitting claims to the Government in violation of the Stark Law. As part of the settlement, Memorial entered into a 5year CIA with the OIG. Millennium Health settled alleged violations of the False Claims Act and Stark Law. The alleged conduct included billing Medicare, Medicaid, and other federal health care programs for medically unnecessary urine drug and genetic testing and for providing free point of care urine drug test cups to physicians expressly conditioned on the physicians' agreement to return the urine specimens to Millennium for additional testing. The claims resolved by the settlement are allegations only, and there has been no determination of liability. Tuomey Healthcare System resolved a $237 million judgment for illegally billing the Medicare program for services referred by physicians with whom the hospital had improper financial relationships, by paying the U.S. $72.4 million and selling Tuomey to Palmetto Health. The judgment related to violations of the Stark Law. As part of the settlement, Tuomey will be required to retain an IRO to monitor any arrangements it makes with physicians or other sources of referrals for the duration of the 5-year CIA. Nurses' Registry and Home Health Corporation ("Nurses' Registry") and the Estate of its former owner, the deceased Lennie House, have agreed to the entry of a judgment against them for $16,000,000 to resolve allegations of violating the False Claims Act, Anti-Kickback Statute, and Stark Law. The alleged conduct including Nurses' Registry delivering bottles of liquor and other enticements to referral sources in order to ensure more valuable

-4-

Settlement Settlement Judgment Judgment

Settlement follows the 5/8/13 Verdict. See also 9/27/16 settlement for

Ralph J. Cox III.

See 7/7/15 Settlement with Vicki House.

Date

Defendant

Jurisdiction

Amount

Description

Type1

Misc. Notes

9/21/15 9/15/15 9/4/15

Adventist Health System

North Carolina

North Broward Hospital District

Florida

Columbus Regional Healthcare System and Dr. Andrew Pippas

Georgia

$115,000,000 $69,500,000 $25,425,000

patient referrals that could be billed to Medicare. Under the terms of the settlement agreement, Nurses' Registry will be sold to an independent third party within 90 days, and 70 percent of the net sale proceeds will be remitted to the federal government. In addition, the Estate of Lennie House will have one year to sell off all of its assets and will turn over 75 percent of those net sale proceeds to the government. Adventist Health System settled alleged violations of the False Claims Act for maintaining improper compensation arrangements with referring physicians and by miscoding claims with the federal government. The alleged arrangements included that Adventist paid bonuses to employed physicians based on a formula that incorporated the value of the physicians' referrals to Adventist, and that Adventist submitted bills to Medicare for its employed physicians' professional services containing certain improper coding modifiers that obtained greater reimbursement. The claims settled by this agreement are allegations only, and there has been no determination of liability. North Broward Hospital District settled allegations that it violated the False Claims Act by engaging in improper financial relationship with referring physicians. The allegation was that North Broward provided compensation to nine employed physicians that exceeded the fair market value of their services in violation of the Stark Law and the False Claims Act. The claims settled by this agreement are allegations only, and there has been no determination of liability.

Columbus Regional Healthcare System and Dr. Andrew Pippas settled allegations with the federal government and Georgia that they violated the False Claims Act by submitting claims in violation of the Stark Law and submitted claims for payment to federal health care programs that misrepresented the

-5-

Settlement Settlement Settlement

Columbus: $25,000,000 Columbus Contingent Payments not to exceed:

$10,000,000 Dr. Pippas: $425,000

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download