Press Release
U.S. Department of Justice
United States Attorney
District of Hawaii
PJKK Federal Building (808) 541-2850
300 Ala Moana Blvd., Room 6-100 FAX (808) 541-2958
Honolulu, Hawaii 96850
For Immediate Release
Contact: Elliot Enoki
June 3, 2009
MEDICAL CENTER PAYS $2.5 MILLION
TO RESOLVE ALLEGATIONS OF IMPROPER CLAIMS
HONOLULU, HAWAII –Queen's Medical Center ("QMC") of Honolulu, Hawaii has paid a total of $2.5 million to settle two lawsuits alleging that QMC over billed the Medicare program, the State of Hawaii Medicaid program, and TRICARE, the federal health benefits program for military dependents. The settlement grew out of civil "whistleblower" suits brought in federal and state court by two former QMC pharmacy technicians under the federal and State of Hawaii False Claims Acts.
Edward H. Kubo, Jr., United States Attorney for the District of Hawaii, said that the Acts allow the government to seek up to triple damages, plus penalties, for false and fraudulent claims submitted to government programs. The former technicians alleged that QMC submitted false bills for pharmaceuticals dispensed at the hospital, and billed federal programs for services provided by residents without the level of supervision required by federal rules. The federal and state governments initiated an investigation based on the allegations of the two former QMC pharmacy technicians.
According to the settlement agreement signed on April 27, 2009, the federal and state governments contended that (1) from September 8, 1999 through October 28, 2002, QMC submitted false claims to Medicare, Medicaid and TRICARE seeking payment for the dispensation of anti-psychotic medications allegedly ordered by a psychiatrist, whereas the medications were actually ordered by non-psychiatrist physicians without the prior knowledge of a psychiatrist; and (2) from July 1, 1999 through June 30, 2006, QMC wrongfully submitted claims to Medicare, Medicaid, and TRICARE for services it represented were provided by teaching physicians when QMC did not have the documentary evidence necessary to demonstrate that the teaching physicians were involved in the services to the degree necessary to support payment of the claims. Under Medicare rules, QMC was permitted to bill for certain services rendered by residents, provided that the residents were supervised by teaching physicians. While QMC agreed to the settlement, it has denied the government's contentions.
Under the terms of the settlement agreement, QMC has paid the federal government $2 million, and an additional $500,000 to attorneys for the two former QMC pharmacy technicians. As part of the settlement, QMC also entered a corporate integrity agreement with the United States Department of Health and Human Services, Office of Counsel to the Inspector General. Under the agreement, QMC will maintain a compliance program designed to assure that its billings conform to all applicable program rules for a period of five years. QMC pledged to continue its efforts to provide high quality health care while continuing to foster a culture of compliance with health care program rules.
“Settlements such as this demonstrate yet again that submitting false claims to federal health care programs artificially raises health care costs and in turn takes from those who depend on these government medical programs,” said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the Office of Inspector General, U.S. Department of Health and Human Services. “My agency, working with our federal and state law enforcement partners, will continue to aggressively investigate and prosecute such fraud.”
The United States has shared $400,000 of the settlement proceeds with the two pharmacy technicians who initiated the suit. Kubo praised the two technicians for their courage in coming forward with the case, and expressed appreciation for the efforts of their legal counsel, Warren Price III and Thomas Grande of Honolulu.
Kubo also credited the Office of Audit Services, Office of Inspector General, U.S. Department of Health and Human Services, for providing audit support which developed the case. The investigation was conducted by the Office of Investigations, Office of Inspector General, U.S. Department of Health and Human Services, the Defense Criminal Investigative Service, and the State of Hawaii Attorney General's Medicaid Investigations Division. The case was handled by Assistant U.S. Attorney Larry Tong, Senior Counsel Gregory Wellins, Office of Counsel to the Inspector General, U.S. Department of Health and Human Services, and Deputy Attorney General Michael Parrish of the State of Hawaii.
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