Community Health Accused of Filing False Medicare Claims
(photo courtesy of Community Health Network)
The U.S. Department of Justice has filed a complaint against Community Health Network.
The DOJ says the health network submitted false Medicare claims, which violates the Stark Law.
The Stark Law, according to the department, “prohibits a hospital from billing Medicare for services referred by a physician with whom the hospital has an improper financial relationship that does not meet any statutory or regulatory exception.”
The complaint says the health network had a number of employment relations with physicians who did not meet the Stark Law exception. Instead, these doctors were supposedly paid “well above fair market value” and the doctors were paid a bonus after they referred a minimum number of patients to the hospital.
The complaint also says that Community Health Network then submitted claims to Medicare from these referrals knowing that those claims were ineligible for payment.
“Our goal at the U.S. Attorney’s Office is to serve the citizens and help ensure safety in their communities,” said U.S. Attorney Josh Minkler for the Southern District of Indiana. “Hospitals are responsible for not only the health and well-being of their patients, but are also required to establish a compliance program in order to protect against improper payments, fraud and abuse as a condition of enrollment in the Medicare program.”
Community Health Network released the following statement to Inside INdiana Business:
“Community Health Network is committed to upholding the highest regulatory and ethical standards in all our business practices, including physician compensation. We have cooperated fully with the government’s requests leading up to this point, and we are disappointed with their decision. We believe that it is a waste of the government’s time and resources to pursue these meritless claims.
This lawsuit involves certain administrative issues that are completely unrelated to patient care. We are confident that we have complied with the laws and regulations that govern the way we operate our health network. We are committed to fighting these allegations which have no merit.
We are confident that we have complied with the law and regulations that govern the way we pay our physicians for the services they provide to our patients and to the communities we serve – services such as teaching, research, providing education to patients and developing protocols to enhance care delivery.
Community recognizes that physician compensation is very complex and highly regulated. Our physician compensation practices are a key part of our overall compliance efforts. We are confident that we operate in a legally compliant manner. To ensure compliance, as is standard in the industry, Community uses a variety of resources including independent, third parties to evaluate physician compensation to ensure it is fair, as the law requires.
We are proud to provide our patients with convenient access to exceptional healthcare services, where and when they need them—in hospitals, health pavilions and doctor’s offices, as well as workplaces, schools and homes”