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Justice News

Department of Justice
U.S. Attorney’s Office
Western District of Michigan

FOR IMMEDIATE RELEASE
Monday, March 23, 2015

Portage Hospital Pays $4.44 Million To Resolve Voluntary Disclosure Regarding False Medicare Clains For Health Care Services

          GRAND RAPIDS, MICHIGAN – Portage Hospital, LLC, in Hancock, Michigan, has agreed to pay the United States $4,446,392.43 to settle allegations that a hospital-owned home health care agency, Portage Health Home Care & Hospice, violated the False Claims Act by submitting false claims to Medicare for home health care services purportedly rendered by a staff physical therapist.

           The settlement stems from a self-disclosure to the U.S. Department of Health & Human Services, Office of Inspector General (“HHS-OIG”) by Portage Hospital. Based on information provided by Portage Hospital, the United States alleged that physical therapy services that the staff therapist provided to Medicare home health care patients between January 1, 2006 and November 30, 2013 were medically unnecessary, lacked adequate documentation of medical necessity, and/or did not qualify for payment by Medicare. The United States alleged that while the staff therapist claimed to be performing between 1,889 and 3,352 home health care visits each year, his documentation generally failed to establish, among other things, patients’ homebound status and the need for skilled therapy services.

          “Portage Hospital is to be commended for disclosing this matter,” said U.S. Attorney Patrick A. Miles, Jr. “Self-disclosures by providers are critical to protecting the integrity of federal health care programs. My office is committed to bringing voluntary disclosures to resolution as quickly and efficiently as is reasonably possible.”

          “A health care provider’s decision to self-disclose its improper behavior benefits both the provider, in this case a hospital, and Federal health care programs, and we will continue to work with our law enforcement partners and providers to reach prompt, appropriate settlement of conduct disclosed in good faith,” said Special Agent in Charge Lamont Pugh III, U.S. Department of Health & Human Services, Office of Inspector General.

          The United States encourages health care providers to self-disclose any violations that have resulted in the submission of improper claims to federal health care programs. A timely voluntary disclosure can result in a significantly reduced penalty. This case was investigated by HHS-OIG and the U.S. Attorney’s Office for the Western District of Michigan. Assistant U.S. Attorney Adam B. Townshend represented the United States.

END

Topic(s): 
Health Care Fraud
Updated November 24, 2015