Report on Medicare Compliance 29, no. 6 (February 17, 2020)
◆ Tenet Healthcare Corp. and an affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.41 million to settle False Claims Act (FCA) allegations they billed Medicare for implanting unnecessary cardiac monitors, the Department of Justice said[1] Feb. 11. According to the settlement, DOJ contends it has certain civil claims against Tenet and the hospital “arising from medically unnecessary claims submitted to Medicare for certain implantations of cardiac event recorders (HCPCS code C1764).” The FCA lawsuit was set in motion by a whistleblower, Michael Grace, who was the risk manager and patient safety officer at Desert Regional Medical Center, said his attorney, Vince McKnight, of Sanford Heisler Sharp. He said the complaint is still sealed. In a statement, Tenet said the settlement relates to a portion of cardiac loop recorder devices implanted from 2014 to 2017. “We stand behind the efforts of our team—our hospital and physicians identified and took steps to address this matter prior to the filing of the lawsuit and remain committed to full compliance with all federal healthcare program requirements.”
◆ Neurosurgeon William Choi and three of his companies have agreed to pay $2.35 million to settle false claims allegations in connection with kickbacks he received from distributors of spinal implant devices he used in spinal surgeries, the U.S. Attorney’s Office for the District of Colorado said[2] Feb. 12. In 2011 and in 2015, Choi created Nexus Spine LLC and 4D Spine LLC, distributorships of spinal equipment. They provided spinal implant equipment, such as rods, screws and cages, to hospitals for use in surgeries that he performed. “Dr. Choi arranged for third parties to serve as the registered owners of both Nexus and 4D, while he secretly maintained control of both distributorships and the money those distributorships made,” the U.S. attorney’s office alleged. “Through this arrangement, Dr. Choi solicited and received from Nexus and 4D improper payments and other benefits.” Medicare, Medicaid and TRICARE paid for the services from Nov. 1, 2012, through June 30, 2017. Choi, who performed spinal surgery at three hospitals “during the time period relevant to this matter,” did not admit liability in the settlement, the U.S. attorney’s office said.
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