Ohio Hospital to Pay $4.1 Million to Resolve False Claims Act Allegations
Cincinnati-based West Chester Hospital and its parent company, UC Health, have agreed to pay $4.1 million to settle allegations that West Chester Hospital violated the False Claims Act by billing federal health care programs for costs associated with medically unnecessary spine surgeries, the Justice Department announced today.
“Hospitals have a responsibility to ensure that services provided at their facilities are medically necessary and appropriate before they bill federal health care programs for those services,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “When providers charge for medically unnecessary services, we will aggressively seek remedies under the False Claims Act.”
This settlement resolves allegations that West Chester Hospital knowingly submitted claims to Medicare and Medicaid for hospital charges related to medically unnecessary spine surgeries performed between 2009 and 2013 by Dr. Abubakar Atiq Durrani, a surgeon from Mason, Ohio, who had admitting privileges at West Chester Hospital. Durrani was arrested in July 2013 and charged with health care fraud violations relating to allegations that he performed medically unnecessary spine surgeries on patients residing in Ohio and Kentucky. Following his arraignment, Durrani allegedly fled the United States and remains a fugitive.
Medicaid is funded jointly by the states and the federal government. The state of Ohio and commonwealth of Kentucky paid for some of the Medicaid claims at issue and will receive approximately $72,000 of the settlement amount.
“Federal health care programs cover only those procedures that are medically necessary,” said U.S. Attorney Carter M. Stewart of the Southern District of Ohio. “The U.S. Attorney’s Office is committed to pursuing providers that seek payment for unnecessary medical procedures.”
“Any time greed replaces medical necessity as the primary factor in performing invasive procedures and surgeries on Medicare and Medicaid patients, our most vulnerable citizens – the elderly, disabled, and economically disadvantaged – are imperiled,” said Special Agent in Charge Lamont Pugh of the Health and Human Services Office of Inspector General (HHS-OIG). “Medical businesses and physicians who unnecessarily place patients at risk to boost profits will be held accountable for their actions.”
The civil settlement resolves a lawsuit filed under the whistleblower provisions of the False Claims Act, which permit private parties to file suit on behalf of the United States for false claims and obtain a portion of the government’s recovery. The civil lawsuit was filed in the Southern District of Ohio by former patients of Durrani and is captioned United States ex rel. Scott, et al. v. Durrani, et al. As part of today’s resolution, the whistleblowers will receive approximately $800,000 from the federal share of the settlement.
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $25.2 billion through False Claims Act cases, with more than $16.1 billion of that amount recovered in cases involving fraud against federal health care programs.
This matter was investigated by the U.S. Attorney’s Office of the Southern District of Ohio and the Civil Division’s Commercial Litigation Branch, with assistance provided by HHS-OIG. The claims resolved by this settlement are allegations only and there has been no determination of liability.