A pediatrician who alleged that a Missouri hospital paid illegal referral fees for patients was awarded $825,000 as part of a False Claims Act settlement.
The settlement resolved allegations in a qui tam lawsuit filed by Dr. Jean Moore. She worked as a pediatrician in Mercy Clinic Springfield Communities, formerly known as St. John’s Clinic.
Under the False Claims Act, private citizens can sue on behalf of the government for false claims and share in any recovery.
Dr. Moore will receive $825,000 from the recovery, the DOJ said.
Mercy Health Springfield Communities, a hospital owner, agreed to pay the United States $5.5 million to settle allegations that it violated the False Claims Act by “engaging in improper financial relationships with referring physicians,” the DOJ said.
Federal law restricts financial relationships that hospitals and clinics can have with doctors who refer patients to them.
The lawsuit alleged the hospital owners submitted false claims to the Medicare program by using “a formula that improperly took into account the value of the physicians’ referrals of patients to the clinic.”
“This settlement protects patients and the public by enforcing the federal protections against illegal profit incentives for physicians,” U.S. Attorney Tammy Dickinson of the Western District of Missouri said.
The claims were allegations only and there was no determination of liability, the DOJ said.
Since January 2009, the Justice Department has recovered a total of more than $24.9 billion through False Claims Act cases. More than $15.9 billion of that amount was recovered in cases involving fraud against federal health care programs.
The case was United States ex rel. Moore v. Mercy Health Springfield Communities f/k/a St. John’s Health System, Inc., et al., Case No. 13-3019-CV (W.D. Mo.).
Richard L. Cassin is the publisher and editor of the FCPA Blog. He can be contacted here.