Showing posts with label tricare. Show all posts
Showing posts with label tricare. Show all posts

Monday, September 7, 2015

Whistleblower allegations leads to Columbus Regional paying $35 million settlement

A whistleblower's allegations of fraud by Columbus Regional Health has led the healthcare corporation agreeing to pay $35 million to settle fraud claims brought by the federal and Georgia government. 

Columbus Regional Healthcare System, John B. Amos Cancer Center, Columbus Radiation Oncology Center, Regional Oncology LLC, and Dr. Andrew W. Pippas are all defendants in the court case. Richard Barker was the whistleblower who brought the fraud allegations to the governments' attention.

In the agreement filed in U.S. District Court for the Middle District of Georgia, the defendants will pay $25 million and up to a maximum of $35 million to settle claims under the False Claims Act.

Richard Barker, as the whistleblower in the case, will receive 15% of the initial $10 million settlement with additional payments still to be negotiated between the governments and Mr. Barker.

The government alleged that the health care institutions falsely billed fees higher than were supported by documentation in the patients’ medical records between May 2006 and May 2013. Submission of claims to Medicare, Medicaid, Federal Employees Health Benefits Program (FEHB), and TRICARE for Intensity-Modulated Radiation Therapy (IMRT) treatments did not qualify to be billed as IMRT during the period from July 15, 2010 through 2012. In addition, the government claims that CRHS made improper salary and medical directorship payments to Dr. Pippas resulting in improper claims to Medicaid and Medicare for reimbursement between 2003 and 2013.

The initial $10 million will be paid immediately with an additional $15 million plus interest to be paid over five years. In addition, the defendants have agreed to pay 1.5% of all annual net patient revenues that exceed $445 million between fiscal years 2016 through 2020.  The defendants will also pay all annual earnings that exceed $3.3 million from the joint venture of TMC with HealthSouth Corporation known as the Rehabilitation Hospital of Phenix City LLC. Total recovery shall not exceed $35 million.

In making these payments, the defendants did not admit any liability.

Columbus Regional Health describes itself as established in 1986 as a not-for-profit health services organization with roots going back to 1836. It refers to itself as "the region's health care leader offering compassionate care and an unwavering commitment to the residents of the region."

Case 4:12-cv-00108-CDL Document 112 Filed 09/04/15