PREMIER MEDICAL STAFFING, INC. AND SOUTHERN NEW HAMPSHIRE MEDICAL CENTER AGREE TO RESOLVE ALLEGATIONS RELATED TO THEIR EMPLOYMENT OF AN INDIVIDUAL WHO WAS EXCLUDED FROM FEDERAL HEALTH CARE PROGRAMS
CONCORD, NEW HAMPSHIRE - United States Attorney John P. Kacavas and Susan J. Waddell, the Special Agent in Charge of the Office of Investigations, Office of Inspector General, United States Department of Health and Human Services (“HHS”), announced yesterday that Premier Medical Staffing, Inc. (“Premier”) and Southern New Hampshire Medical Center (“SNHMC”) have agreed to pay civil settlements totaling $123,400.00 to resolve allegations related to the employment of an individual who previously had been excluded from participating in Federal health care programs.
Premier is a New Hampshire corporation that is in the business of providing temporary staffing services for health care providers. Between December 3, 2004, and June 1, 2006, Premier employed a licensed nursing assistant/certified nursing assistant who had been excluded from Federal health care programs. Premier placed this individual at a number of hospitals and other health care facilities where the individual performed services that were paid for by Medicare, Medicaid, and other Federal health care programs. Because the individual had been excluded from Federal health care programs, these hospitals and other health care facilities were not entitled to bill or receive payment for such services. Without admitting any liability, Premier agreed to pay $90,000.00 to the United States to resolve allegations that it violated the False Claims Act by placing this excluded individual at these hospitals and health care facilities.
SNHMC is a not-for-profit acute care hospital located in Nashua, New Hampshire. Between February of 2002 and September of 2007, SNHMC contracted with various temporary staffing agencies to obtain the services of the same excluded individual referenced above. The individual performed services at SNHMC that were paid for, in part, by Medicare, Medicaid, and other Federal health care programs. Because the individual had been excluded from Federal health care programs, SNHMC was not entitled to bill or receive payment from the Federal health care programs for these services. Without admitting any liability, SNHMC agreed to pay $33,400.00 to the United States to resolve allegations that it violated the False Claims Act by submitting claims to Federal health care programs for this individual’s services.
Under federal law, the Office of Inspector General of HHS can exclude individuals from participating in federal health care programs, including the Medicare, Medicaid, and TRICARE programs. Bases for exclusion are discussed on the Inspector General’s website: www.oig.hhs.gov. Under federal law, no Medicare or other federal health program payments may be made with respect to items or services (even administrative and management services) that are furnished by an excluded individual. In many instances, the practical effect of such an exclusion is to preclude employment of an excluded individual in any capacity by a health care provider that receives reimbursement, indirectly or directly, from any federal health care program.
Submitting claims to federal programs such as Medicare or Medicaid for services provided by an excluded individual may give rise to liability under the civil False Claims Act. Under the False Claims Act, if it is established that a person has submitted false or fraudulent claims to the United States, the United States can recover treble damages and $5,500 to $11,000 for each false or fraudulent claim filed.
Both Premier and SNHMC cooperated in the government’s investigations. No patients were harmed or put in any jeopardy by the employment of the excluded individual.
In addition to entering into the Settlement Agreement, both entities have certified that they will follow certain policies and procedures to ensure that they do not employ such excluded individuals in the future.
This case was investigated by members of the Office of Investigations of the Office of Inspector General of the United States Department of Health and Human Services, with assistance from the Medicaid Fraud section within the New Hampshire Attorney General’s Office. The case was handled by Assistant United States Attorney John J. Farley.