3 Central Ohio health providers to pay more than $3 million for improper claims submitted to Medicare and Ohio Bureau of Workers’ Compensation

COLUMBUS, Ohio – The United States and the Ohio Bureau of Workers’ Compensation have reached three related settlements totaling more than $3 million with Orthopedic & Neurological Consultants, New Albany Surgery Center, and Mount Carmel Health System, for improper claims submitted to Medicare and the Ohio Bureau of Workers’ Compensation.

Orthopedic & Neurological Consultants (OrthoNeuro) is a large orthopedic practice in Central Ohio. One of its doctors and part owner, Robert Nowinski, now deceased, billed for certain complex shoulder surgeries that either did not occur within the standard of care or did not occur at all. Dr. Nowinski routinely billed for complex, time-consuming shoulder surgeries despite spending a fraction of the time in the operating room as would be expected and required to complete such surgeries. He frequently did not use the specific supplies required for the designated surgery.

Nowinski used the operating room facilities at New Albany Surgery Center (NASC), an ambulatory surgery center and a joint venture with OrthoNeuro and Mount Carmel Health, and at Mount Carmel’s New Albany Surgical Hospital.

NASC and Mount Carmel billed “facility fees” to Medicare and Ohio BWC relating to the surgeries allegedly performed at those facilities by Dr. Nowinski. OrthoNeuro billed Medicare and Ohio BWC for Dr. Nowinski’s professional services involved in the suspect procedures. 

As part of the settlement, OrthoNeuro will pay $498,182 to Medicare and $533,482 to BWC; NASC will pay $772,650 to Medicare and $468,406 to BWC; and Mount Carmel will pay $760,901 to Medicare and $156,139 to BWC.

While the settling parties did not appear to intentionally submit false claims arising from Dr. Nowinski’s surgical procedures, the government concluded that there was evidence that should have provided notice of Dr. Nowinski’s wrongdoing to the settling parties.

“The United States will aggressively pursue providers that bill for services not performed within the appropriate standard of care, as well as entities whose compliance programs fail to identify egregious wrongdoing by their providers.  Here, the settling parties have fully cooperated with the government’s investigation and promptly worked with the United States and Ohio BWC to reach a swift and equitable resolution,” said U.S. Attorney Kenneth L. Parker.

Kenneth L. Parker, United States Attorney for the Southern District of Ohio; Stephanie McCloud, Administrator of the Ohio Bureau of Workers’ Compensation; the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG); J. William Rivers, Special Agent in Charge, Federal Bureau of Investigation (FBI), Cincinnati Division; and the U.S. Department of Labor announced the charges. Civil Chief Andrew M. Malek and Assistant U.S. Attorney Kenneth F. Affeldt are representing the United States in this case.

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