Friday Enforcement Wrap

Texas Hospital to Pay Over $3 Million to Resolve False Claims Act Allegations

John Peter Smith Hospital (JPS) agreed to pay more than $3.3 million to settle allegations that it violated the False Claims Act by upcoding hundreds of claims submitted to federal healthcare programs.

According to DOJ’s press release, the hospital is alleged to have improperly appended billing modifiers -25, -59, and -XU to hundreds of claims, which are used to indicate that a provider administered significant care on the same day as another medical procedure that far exceeded the preoperative and postoperative care included in the main procedure care. JPS is alleged to have used the modifiers to effectively double bill for aspects of patients’ care.

This settlement resolves allegations filed by the former Director of Compliance at JPS, who will receive approximately $912,635 from the lawsuit. DOJ’s press release notes that although it did not intervene in the case, it worked collaboratively with the former employee and her counsel in investigating and resolving the case.

Read DOJ’s press release here.

Missouri Healthcare System to Pay $1.6 Million to Resolve Government’s Claims under the Controlled Substance Act

Saint Francis Medical Center (SFMC), a southeast Missouri healthcare system, agreed to pay over $1.6 million to resolve allegations that one of its physician’s wrote prescriptions for controlled substances without legitimate medical purposes in violation of the Controlled Substances Act. The physician is also alleged to have ignored warning signs of drug diversions and misuse, such as patients’ previous hospital treatment for medical problems related to drug misuse. As a result of the physician’s actions, SFMC issued invalid prescriptions for addictive opioids, including morphine, hydromorphone, and oxycodone. Although unrelated to the settlement, SFMC voluntarily incorporated a Foundation for Opioid Prescribing Education to educate physicians and other healthcare professionals in the area on the best practices to adhere to when prescribing opioids and managing patients suffering from chronic pain issues.

Read DOJ’s press release here.

Pennsylvania Man Charged in Covid-19 Fraud Case

A Pennsylvania man was charged in a criminal information for an alleged wire fraud scheme to obtain over $400,000 through the Small Business Administration’s Economic Injury Disaster Loan (EDIL) program. According to DOJ’s press release, the individual submitted fraudulent loan applications in the names of other individuals (unbeknownst to them) and then opened two bank accounts to receive the EIDL funds. The government has seized over $100,000 in fraudulent obtained funds.

Read DOJ’s press release here.