A hospital system based in Michigan agreed to settle a whistleblower claim for $2.8 million, ending a case that featured allegations it submitted false claims for medically unnecessary procedures.
Ascension Michigan comprises St. John Hospital and Medical Center, St. John Macomb Oakland Hospital, Providence Park Hospital and Ascension Crittenton Hospital. The group agreed to pay the settlement figure to resolve allegations that a gynecologic oncologist regularly performed operations that were above the standard of care.
According to a press release issued by the U.S. Department of Justice, the doctor performed hysterectomies that were medically unnecessary, then did not return the money the government paid for patients covered under various federal healthcare programs to conduct those operations.
The alleged conduct occurred between 2011 and 2017. During that time, Ascension Michigan is alleged to have knowingly submitted false claims to those federal programs, including claims for those hysterectomies as well as claims for chemotherapy services that were not medically necessary, and evaluation and management services from the doctor that were either not performed or not provided as represented in the claims.
The release alleged Ascension Michigan realized the doctor had higher than average rates of complications after performing these procedures and higher than normal numbers of patient complaints. A third-party review concluded the doctor could have used less aggressive procedures on the patients, resulting the doctor being placed on a performance improvement plan and ultimately being let go by the company.
Healthcare fraud costs the federal government billions of dollars every year, and many times it is only through information provided by whistleblowers that federal officials even become aware of its presence. If you have information about a fraudulent scheme occurring within a healthcare organization, contact an experienced attorney at Kardell Law Group to learn about your legal options to ensure justice is done.