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HCA - Parkridge Fined $16.5 Million

HCA Inc., one of the nation’s largest private hospital chains, has agreed to pay $16.5 million to settle alleged violations of the Ethics in Patient Referrals Act (also known as the Stark law), the False Claims Act, and other federal and state laws and regulations in connection with the operation of its subsidiary, Parkridge Medical Center, Inc., in Chattanooga. In addition, Parkridge Medical Center has entered into a comprehensive five-year Corporate Integrity Agreement with the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG) to ensure its continued compliance with federal health care benefit program requirements.

During 2007, HCA, through its subsidiaries Parkridge and HCA Physician Services (HCAPS), entered into a series of financial transactions with a physician group, Diagnostic Associates of Chattanooga, through which it provided financial benefits intended to induce the physician members of Diagnostic to refer patients to HCA facilities. The financial benefits included lease of office space from Diagnostic at a rental rate well in excess of fair market value to meet the mortgage obligations of the Diagnostic members and release of Diagnostic members from a separate lease obligation. These financial arrangements violated the Ethics in Patient Referrals Act and the Anti-Kickback Statute – laws designed to protect patients as well as the integrity of government-funded health care benefit programs such as Medicare, Medicaid, TRICARE, and TennCare.

As U.S. Attorney Bill Killian explained, “Physicians should make decisions regarding referrals to health care facilities based on what is in the best interest of patients without being induced by payments from hospitals competing for their business.”

Federal law prohibits hospitals from submitting claims to government-funded health care benefit programs for inpatient and outpatient hospital services referred, ordered, or arranged for by physicians who have prohibited financial arrangements with those hospitals.

"We will not allow hospitals to provide financial incentives to induce physicians to steer patients their way," said Derrick L. Jackson, Special Agent in Charge, HHS-OIG in Atlanta. "These arrangements can corrupt medical decision-making and may result in unnecessary diagnostic testing and hospital admissions."

During the period from 2007 through 2011, HCA through Parkridge, submitted or caused to be submitted claims to Medicare, TRICARE, and TennCare/Medicaid for inpatient and outpatient hospital services referred, ordered or arranged for by the Diagnostic physician members who benefitted from the prohibited financial arrangements between HCA Diagnostic. Medicare and the other health care benefit programs paid the claims for those hospital services, and this settlement addresses the financial harm to the Medicare and Medicaid trust funds, TriCare and TennCare for the moneys paid out of those funds which HCA improperly claimed and received during that time period. Under the False Claims Act, a recipient of such funds may be liable for as much as three times the amount paid by the government program plus civil penalties.

The determination of the losses suffered by the government in a False Claims Act case based on violations of the Stark law depends largely upon the number of physicians who benefitted from the financial arrangements with the hospital, the number of patients referred by those physicians to the hospital, and the amount paid by the government to the hospital for claims submitted for all those patients. The False Claims Act further provides for trebling of any losses and penalties of between $5,500-$11,000 per claim.

“Today's settlement is the third since 2005 involving violations by hospitals in Chattanooga of the Ethics in Patient Referrals and False Claims Acts and reflects the Justice Department's continued determination to enforce these laws to protect both patients and the Medicare and Medicaid trust funds,” said U.S. Attorney Killian. Mr. Killian further noted that this settlement resulted from a comprehensive investigation which began as a result of a qui tam or whistleblower complaint filed in 2008. After an administrative subpoena was served on HCA subsidiaries in July 2009, HCA produced documents to the United States and made its personnel available for interviews.

"The Defense Criminal Investigative Service is committed to ensuring that TRICARE, the U.S. military health care program, continues to provide safe and superior medical care to America's Warfighters and their families." said John F. Khin, Special Agent in Charge, Defense Criminal Investigative Service- Southeast Field Office. "The successful resolution of this case demonstrates the effectiveness of joint investigations to combat health care fraud and preserve the integrity of this vital program."

Tennessee Attorney General Bob Cooper noted: "We are proud to have worked closely with our federal partners to bring this case to resolution. Combating fraud is essential to the strength and integrity of the TennCare program and is a high priority of this office."

HCA - Parkridge Fined $16.5 Million

Wednesday, September 19 2012, 01:06 PM EDT

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Last Update on December 18, 2014 08:45 GMT

ECONOMY-THE DAY AHEAD

WASHINGTON (AP) -- Labor Department releases weekly jobless claims, 8:30 a.m. Eastern Time.

Mortgage company Freddie Mac releases weekly mortgage rates, 10 a.m.

Conference Board releases leading indicators for November, 10 a.m.

SONY HACK-NORTH KOREA

NEW YORK (AP) -- A U.S. official says North Korea perpetrated an unprecedented act of cyberwarfare against Sony Pictures that exposed tens of thousands of sensitive documents and escalated to threats of terrorist attacks that ultimately drove the studio to cancel all release plans for "The Interview," the film at the heart of the attack.

Federal investigators have now connected the Sony Pictures hack to the isolated communist nation, according to an official who spoke on condition of anonymity because the official was not authorized to openly discuss an ongoing criminal case.

Earlier in the day, the besieged company said it was canceling the Christmas Day release of "The Interview." It cited the threats of violence against movie theaters and decisions by the largest multiplex chains in North America, one after another, to pull the film from its screens.

The attack is unprecedented and possibly the costliest for a U.S. company ever, says Avivah Litan, a cybersecurity analyst at research firm Gartner.

UBER-SAFETY

LOS ANGELES (AP) -- Taxi alternative Uber is responding to public concerns that its drivers are not adequately screened for past criminal convictions by promising to focus on rider safety.

Uber's head of global safety wrote in a blog post Wednesday that in 2015 the company will "build new safety programs and intensify others."

The initiatives will include new ways to screen drivers and the creation of teams that can rapidly respond to safety-related reports.

The blog referenced a case in India in which a driver was accused of raping a passenger. It didn't mention a lawsuit filed by California prosecutors which says the company's safety checks of drivers fall short.

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