A Michigan-based hospital system has agreed to pay $2.8 million to resolve whistleblower allegations that they submitted false claims for allegedly unnecessary procedures. The hospital group, composed of St. John Hospital and Medical Center, Providence Park Hospital, St. John Macomb Oakland Hospital and Ascension Crittenton Hospital (collectively, Ascension Michigan), agreed to pay in order to resolve claims that one of their gynecologic oncologists (known here as “the Doctor”) routinely performed operations that were above the standard of care. According to an August 5 U.S. Department of Justice press release, the Doctor performed medically unnecessary radical hysterectomies, and then did not return the money that the government paid for patients covered under federal health care programs to have the operations conducted.
The press release alleges that between 2011 and 2017, Ascension Michigan knowingly submitted false claims to federal medical programs and held on to money that should have been returned to the programs because the procedures that the claims were based on were unnecessary. False claims that Ascension Michigan allegedly submitted included the hysterectomies, but also contained claims for “chemotherapy services that the Doctor administered or ordered that were not medically necessary, and evaluation and management services by the Doctor that were not performed or not rendered as represented.”
Ascension Michigan allegedly realized the Doctor had higher than average rates of complications stemming from procedures, as well as higher than normal patient complaints. Ascension Michigan allegedly hired a “third-party doctor to conduct a peer review of a sample of the Doctor’s patients.” This third-party doctor concluded that many of the patients could have had a less invasive or aggressive surgery than the operation that the Doctor actually performed on them. The Doctor was then placed on a performance improvement plan and later let go by the medical company. Ascension Michigan also made a submission under the Provider Self-Disclosure Protocol of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) in June of 2018, disclosing and calling attention to the claims and fees that the medical company had submitted to federal medical programs on behalf of the Doctor. The press release notes that Ascension Michigan cooperated in the government’s investigation.
“When hospitals receive payment from federal health care programs for medically unnecessary surgical procedures, they cannot simply retain those payments; they have an obligation to return them,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “We will continue to ensure that taxpayer funds are used appropriately for the important programs that they support.”
The whistleblowers in the case, Pamela Satchwell, Dawn Kasdorf, and Bethany Silva-Gomez, filed under the qui tam provisions of the False Claims Act. This makes them eligible for a 15 to 30% stake of the total money recovered by the government. For their part in revealing these alleged False Claims Act violations, the three whistleblowers will equally share a reward of $532,000.