Two Mon­tana hos­pi­tals pay $4 mil­lion

Fol­low­ing in­ter­nal re­view, Sis­ters of Char­ity set­tles Medi­care fraud claims

Modern Healthcare - - REGIONAL NEWS - Joe Carl­son

Two Mon­tana hos­pi­tals spon­sored by the Sis­ters of Char­ity of Leav­en­worth Health Sys­tem are pay­ing fed­eral au­thor­i­ties $4 mil­lion af­ter an in­ter­nal re­view turned up more than 100 po­ten­tially il­le­gal ar­range­ments for pay­ing doc­tors.

The two hos­pi­tals—206-bed St. Vin­cent Health­care in Billings and 25-bed Holy Rosary Health­care in Miles City—re­ported the po­ten­tial prob­lems di­rectly to the U.S. at­tor­ney’s of­fice in Mon­tana and ne­go­ti­ated set­tle­ments of al­leged vi­o­la­tions of the Stark law and False Claims Act.

“We had taken an in­ter­nal re­view of our

pro­cesses and sys­tems up there, and that’s when we dis­closed this,” said Che­ston Tur­by­fill, di­rec­tor of pub­lic af­fairs for Sis­ters of Char­ity of Leav­en­worth Health Sys­tem, which has cor­po­rate of­fices in Den­ver.

The set­tle­ment says the hos­pi­tals “do not con­test” Stark law li­a­bil­ity, but the agree­ment was not an ad­mis­sion of wrong­do­ing un­der the False Claims Act.

The in­ter­nal re­views turned up the names of 86 doc­tors em­ployed di­rectly by the hos­pi­tals who were paid in part on the ba­sis of how much Medi­care rev­enue they gen­er­ated for the hos­pi­tal be­tween 2003 and 2010, which is pro­hib­ited by the Stark law.

“There are lim­i­ta­tions to how the com­pen­sa­tion can be paid to physi­cians,” said Scott Taebel, a Mil­wau­kee at­tor­ney for Hall, Ren­der, Kil­lian, Heath & Ly­man who was not in­volved in the case. “Even though they work for the hos­pi­tals, the com­pen­sa­tion can’t be tied to the vol­ume or value of those re­fer­rals.”

In ad­di­tion, the hos­pi­tals’ au­dits turned up 53 fi­nan­cial ar­range­ments with in­de­pen­dent physi­cian groups that po­ten­tially vi­o­lated the Stark law by com­pen­sat­ing them for re­fer­ring pa­tients to the hos­pi­tals, the U.S. Jus­tice Depart­ment said.

“It is im­por­tant to note that pa­tient care was not com­pro­mised by our physi­cian con­tract­ing ar­range­ments,” Ja­son Barker, St. Vin­cent Health­care pres­i­dent and CEO, said in a state­ment.

“Fur­ther, no pa­tient or gov­ern­men­tal en­tity was billed for any ser­vice that was not pro­vided and the con­tract­ing is­sues did not re­sult in overuti­liza­tion of th­ese ser­vices,” he said.

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