In The News

Missouri Hospital Agrees to Pay United States $5.5 Million to Settle Alleged False Claims Act Violations

Another qui tam Medicare case, brought on by a Medicare fraud whistleblower, reached a settlement this week. Two Southwest Missouri health care providers—Mercy Health Springfield Communities, formerly known as St. John’s Health System Inc., and its affiliate, Mercy Clinic Springfield Communities, formerly known as St. John’s Clinic—agreed to pay the United States $5.5 million to settle allegations that they violated the False Claims Act by engaging in improper financial relationships with referring physicians.

The U.S. alleged that the Missouri health care providers submitted false claims to the Medicare program for services rendered to patients referred by physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals of patients to the clinic. These allegations are in direct violation of federal law that restricts the financial relationships that hospitals and clinics may have with doctors who refer patients to them.

Principal Deputy Assistant Attorney General Benjamin C. Mizer, the head of the Justice Department’s Civil Division, had this to say about the case: “When physicians are rewarded financially for referring patients to hospitals or other health care providers, it can affect their medical judgement, resulting in overutilization of services that drives up health care costs for everyone. In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable.”

As I mentioned earlier, the allegations resolved by this settlement arose from a qui tam lawsuit filed by whistleblower, Dr. Jean Moore, a physician employed by one of the defendants. Dr. Moore will receive a whistleblower reward from the recovery in the amount of $825,000. You can find more information on reporting Medicare fraud here: