In The News

Healthcare Provider Agrees to Pay More than $1 Million to Resolve False Claims Act Allegations

The government has long maintained that healthcare providers who perform unnecessary medical procedures on patients risk public safety and drain its programs of vital resources. That is why last month the Justice Department announced that Grenada Lakes Medical Center (GLMC), a hospital operated by the University of Mississippi Medical Center, agreed to pay more than $1.1 million to resolve allegations that the hospital sought and received funds from Medicare for services that were medically unnecessary. The settlement resolves allegation that from January 2005 to April 2013, the hospital submitted claims for Intensive Outpatient Psychotherapy (IOP) services. These services, the government alleged, did not qualify for Medicare reimbursement which the hospital sought. The IOP services were performed on GLMC’s behalf by Allegiance Health Management a healthcare management firm out of Shreveport, Louisiana.

“Hospitals that participate in the Medicare program are responsible for ensuring that the services performed at their facilities or on their behalf reflect the medical needs of patients rather than the desire to maximize profit,” said Acting Assistant Attorney General Chad A. Readler for the Civil Division. “The Department of Justice will continue to hold accountable those who misspend taxpayer funds by providing medically inappropriate services.” Last month’s settlement follows previous settlements with more than twenty other hospitals where Allegiance provided these kinds of services.

“We will not tolerate hospitals that place profit over legitimate patient care by billing for medically unnecessary services,” said C.J. Porter, Special Agent in Charge for the U.S. Department of Health and Human Services Office of Inspector General. “In coordination with our partners, we will continue to investigate these cases and ensure taxpayer funds are used as intended.”

The settlement reached with GLMC resolves allegations that originated from a lawsuit filed under the whistleblower or qui tam provisions of the False Claims Act. These provisions permit private individual to sue on behalf of the government and to share in any subsequent recovery. For this, defendants usually retain the services of whistleblower lawyers. A qui tam law firm is a firm that specializes in all aspects of the False Claims Act. The whistleblower in this case was Ryan Ladner a former program manager at the Inspirations Outpatient Counseling Center located at Wesley Medical Center in Hattiesburg, Mississippi. Mr. Ladner’s share of the recovery comes to $195,000. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).