St. Helena Hospital, part of the Adventist Health System, agreed to pay the United States $2.25 million to settle allegations that it submitted false claims to Medicare for unnecessary cardiac procedures and unneeded inpatient admissions.
The settlement resolves a lawsuit filed in federal court in San Francisco, California by Kacie Carroll, a former employee of St. Helena Hospital.
Under the qui tam or whistleblower provisions of the False Claims Act, private citizens can to bring lawsuits on behalf of the United States and share in the government’s recovery.
Carroll will receive $450,000, the DOJ said.
The settlement resolves allegations that St. Helena Hospital in Napa Valley knowingly charged Medicare for medically unnecessary angioplasty procedures from 2008 to mid 2011. Angioplasty is used to open narrowed or blocked blood vessels that supply blood to the heart.
The DOJ also alleged that St. Helena Hospital unnecessarily admitted angioplasty patients who should have been treated on a less expensive outpatient basis.
The claims resolved by the settlement are allegations only and there has been no determination of liability, the DOJ said.
The case is United States ex rel. Carroll v. Adventist Health Systems, et al., Case No. CV-10-4925 DMR.
Richard L. Cassin is the publisher and editor of the FCPA Blog. He can be contacted here.