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Business Crimes Hotline
GEORGIA
Settlement Requires Hospital and Physician to Pay over $25 Million
On Sept. 4, 2015, the Department of Justice (DOJ) announced that a settlement had been reached between Columbus Regional Healthcare System (Columbus Regional) and Dr. Andrew Pippas for violations of the Stark Law between 2003 and 2013, and false claims reporting between 2006 and 2013. Pursuant to the settlement agreement, Columbus Regional agreed to pay $25 million, with $10 million due up front, plus additional payments of up to $10 million over the next five years (contingent upon Columbus Regional's future revenue). Pippas agreed to pay nearly $500,000, due immediately. The majority of the funds recovered will go to repay the federal government, with $746,100 being directed to the state of Georgia. Neither party admitted liability as part of the settlement.
Michael Moore, the United States Attorney for the Middle District of Georgia, stated that “[a]ccess to health care is on everyone's mind, especially with respect to rural communities. The type of conduct alleged in this case puts that access at risk.” Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the DOJ's Civil Division, further suggested that the settlement “demonstrates our continuing vigilance to ensure that health care referrals are based solely on the medical needs of the patient and that health care providers bill the government only for the care they provide.”
The Stark Law prohibits a physician from referring a patient to a medical facility in which the physician has a financial interest. In violation of this provision, Columbus Regional admitted to overcompensating Pippas (through salary and directorship payments) for a decade. Had the case not settled, Columbus Regional could have faced over $150 million in liability for all government-backed insurance claims that the overpaid doctor submitted. The False Claims Act (FCA) more broadly imposes liability on companies that defraud governmental programs and, in this case, focused on Columbus Regional's numerous claims to federal health care programs at higher levels than what was actually provided without sufficient documentation.
In addition to the monetary penalty, Columbus Regional is also obligated to enter into a Corporate Integrity Agreement with the Department of Health and Human Services Office of the Inspector General, which mandates Columbus General to employ procedures designed to detect and eliminate similar violations in the future. Moore contends that this requirement ensures the existence of an “appropriately functioning” system that is “accessible to the wide array of the communities” served. This settlement also resolves two federal court lawsuits filed by former administrator of the Columbus Regional's cancer center, Richard Barker. The first lawsuit was initiated under the whistleblower provisions of the FCA and the second accused Columbus Regional of Stark Law violations.
The government viewed this settlement as a victory in further support of its Health Care Fraud Prevention and Enforcement Action Team, launched in May 2009 by the Attorney General and the Secretary of Health and Human Services, which seeks to combat Medicare and Medicaid fraud. ' Colleen Snow, Mayer Brown
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GEORGIA
Settlement Requires Hospital and Physician to Pay over $25 Million
On Sept. 4, 2015, the Department of Justice (DOJ) announced that a settlement had been reached between Columbus Regional Healthcare System (Columbus Regional) and Dr. Andrew Pippas for violations of the Stark Law between 2003 and 2013, and false claims reporting between 2006 and 2013. Pursuant to the settlement agreement, Columbus Regional agreed to pay $25 million, with $10 million due up front, plus additional payments of up to $10 million over the next five years (contingent upon Columbus Regional's future revenue). Pippas agreed to pay nearly $500,000, due immediately. The majority of the funds recovered will go to repay the federal government, with $746,100 being directed to the state of Georgia. Neither party admitted liability as part of the settlement.
The Stark Law prohibits a physician from referring a patient to a medical facility in which the physician has a financial interest. In violation of this provision, Columbus Regional admitted to overcompensating Pippas (through salary and directorship payments) for a decade. Had the case not settled, Columbus Regional could have faced over $150 million in liability for all government-backed insurance claims that the overpaid doctor submitted. The False Claims Act (FCA) more broadly imposes liability on companies that defraud governmental programs and, in this case, focused on Columbus Regional's numerous claims to federal health care programs at higher levels than what was actually provided without sufficient documentation.
In addition to the monetary penalty, Columbus Regional is also obligated to enter into a Corporate Integrity Agreement with the Department of Health and Human Services Office of the Inspector General, which mandates Columbus General to employ procedures designed to detect and eliminate similar violations in the future. Moore contends that this requirement ensures the existence of an “appropriately functioning” system that is “accessible to the wide array of the communities” served. This settlement also resolves two federal court lawsuits filed by former administrator of the Columbus Regional's cancer center, Richard Barker. The first lawsuit was initiated under the whistleblower provisions of the FCA and the second accused Columbus Regional of Stark Law violations.
The government viewed this settlement as a victory in further support of its Health Care Fraud Prevention and Enforcement Action Team, launched in May 2009 by the Attorney General and the Secretary of Health and Human Services, which seeks to combat Medicare and Medicaid fraud. ' Colleen Snow,
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