Date: December 13, 2024
The Sacramento Bee, and other publications, reported on a recent $10.2 million settlement resolving allegations that California-based Oroville Hospital charged government insurance programs for unnecessary medical treatments and incentivized doctors to admit more patients regardless of medical need. One of the whistleblowers in the case, Craig Fisher, was represented by TELG principal Janel Quinn. Mr. Fisher was a physician's assistant in the hospital's emergency room.
[EXCERPT]
To settle Medicare overbilling case, Northern California hospital to pay out more than $10M
Oroville Hospital has agreed to pay more than $10 million to the federal government to settle long-running allegations that the nonprofit medical facility overbilled Medicare and Medicaid while paying kickbacks to doctors, the U.S. Department of Justice and hospital officials said.
The hospital confirmed the settlement, which did not admit wrongdoing, and said it would enter into a “corporate integrity agreement” with regulators. Under the plan, the Butte County hospital will regularly review its claims to Medicare and Medicaid to ensure that treatments are medically necessary and conform to the agencies’ regulations.
>> View full story on The Sacramento Bee
[OFFICIAL ANNOUNCEMENT]
California Hospital to Pay $10.25M to Resolve False Claims Allegations
From the U.S. Department of Justice (December 12, 2024)
Oroville Hospital, located in Oroville, California, has agreed to pay $10,250,000, to the United States and the State of California to resolve allegations that it knowingly submitted false claims to Medicare and Medicaid arising from medically unnecessary inpatient hospital admissions, a kickback and physician self-referral scheme and the use of erroneous diagnosis codes. Oroville Hospital will pay $9,518,954 to the federal government and $731,046 to the State of California.
The United States alleged that Oroville Hospital admitted patients and billed Medicare and Medicaid for more expensive inpatient hospital stays when inpatient care was not medically necessary and observation status or outpatient care was appropriate. The United States also alleged that Oroville Hospital illegally incentivized inpatient admissions by paying financial bonuses to doctors who worked full time at the hospital and were in a position to influence whether or not patients were admitted to the hospital. The bonuses paid by Oroville Hospital took into account the volume or value of admissions by these physicians. Oroville Hospital further allegedly submitted claims to Medicare and Medicaid that included false diagnosis codes for systemic inflammatory response syndrome (SIRS), resulting in excessive reimbursement to the Hospital.
“Improperly billing federal health care programs depletes valuable government resources used to provide medical care to millions of Americans,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will continue to protect these critical programs by pursuing those who knowingly claim reimbursement to which they are not entitled.”
» View press release on Justice.gov
[ADDITIONAL COVERAGE]
Oroville Hospital to pay $10.25M to feds, state to resolve allegations of kickbacks, false billing
From Chico Enterprise-Record (December 13, 2024)
Oroville Hospital has agreed to pay $10.25 million to the federal government and the State of California to resolve allegations that the hospital engaged in illegal kickbacks to physicians and submitted false billing claims to Medicare and Medi-Cal.
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The civil settlement also includes the resolution of claims brought under the “whistleblower” provisions of the False Claims Act by Cecilia Guardiola and Craig Fisher. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery.
This newspaper was unable to find specific details about Guardiola or her complaint. However, an email sent to this newspaper on Thursday provided some additional information on Fisher and his complaint. The email was sent by Jessica Curbelo, a content specialist with the Employment Law Group in Washington D.C.
Curbelo’s email stated Fisher filed his complaint in 2020 but that under the terms of the federal FCA, the case remained secret while it was under investigation. With a settlement agreement in place that complaint was unsealed this week.
Curbelo’s email went on to state that Fisher was a physician’s assistant in the hospital’s emergency room. In his complaint she said he “recounts seeing patients being admitted for minor conditions like a runny nose, or being admitted directly from the waiting room — all in pursuit of kickbacks that lured doctors to work at Oroville from as far away as Los Angeles. The lawsuit, which was filed under the federal FCA and the California FCA, claimed that such practices were illegal and defrauded both Medicare and Medi-Cal.”
» View full story on the Chico Enterprise-Record
Oroville Hospital to pay $10.25 million to settle kickback and false billing allegations
From Action News Now (December 12, 2024)
OROVILLE, Calif. – Oroville Hospital has agreed to pay a significant settlement of $10.25 million to resolve allegations related to kickbacks and false billing practices, the U.S. Department of Justice announced today.
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As part of the settlement, Oroville Hospital has entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General. This agreement requires the hospital to implement a risk assessment and internal review process to identify and address compliance risks. An independent review organization will also assess the medical necessity and appropriateness of select Medicare claims and the hospital’s policies and systems for managing referral arrangements.
The settlement also resolves claims brought under the qui tam (whistleblower) provisions of the False Claims Act.
» View full story on Action News Now
Oroville Hospital to pay $10.25M in kickback, false claim settlement
From KRCR TV (December 12, 2024)
OROVILLE, Calif. — Oroville Hospital has agreed to pay more than $10 million to the state and federal government, as well as two private plaintiffs, to resolve allegations the hospital violated the False Claims Act and the Anti-Kickback Statute, according to the Department of Justice.
