A 223-bed acute care institution with a medical staff of nearly 300 physicians has agreed to pay $50 million over allegations it deliberately submitted ineligible claims to Medicare and profited handsomely by these actions.
As reported by the U.S. Department of Justice Sep. 9, the alleged deeds were done at Wheeling Hospital in West Virginia.
Justice specifically accused the hospital and a management consultancy of systematically violating the Physician Self-Referral Law, aka the Stark Law, as well as the Anti-Kickback Statute from 2007 to 2020.
Justice says the accused “knowingly and willfully” payed “improper compensation to referring physicians that was based on the volume or value of the physicians’ referrals or was above fair market value.”
The hospital made a profit of nearly $90 million within five years of contracting with the consultancy, which made millions of its own for services rendered to Wheeling Hospital, the Pittsburgh Post-Gazette is reporting.
This week’s settlement caps a whistleblower complaint filed in 2017 by a former Wheeling Hospital executive VP, Louis Longo.
Longo will receive $10 million from the payout, Justice says.
“Medicare and Medicaid beneficiaries trust that their healthcare providers will make decisions based on sound medical judgment,” Scott W. Brady, the U.S. Attorney for the Western District of Pennsylvania, says in prepared remarks. “Our office will take decisive action against any medical providers which betray that trust and make medical decisions based on their own financial interests. Our seniors deserve nothing less.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.