JACKSONVILLE, Fla. – Baptist Health System Inc., the parent company for a network of affiliated hospitals and medical providers in the Jacksonville area, has agreed to pay $2.5 million to settle allegations that its subsidiaries violated the False Claims Act by submitting claims to federal health care programs for medically unnecessary services and drugs, the Department of Justice announced Tuesday.
The alleged misconduct involved Medicare, Medicaid, TRICARE and the Federal Employee Health Benefits Program.
"Providers that bill for unnecessary services and drugs contribute to the soaring cost of health care," said Stuart Delery, assistant attorney general for the Justice Department's Civil Division. "Providers must deal fairly and honestly with federal health care programs, and the Justice Department will investigate aggressively and hold accountable those who do not."
The settlement resolves allegations that, from September 2009 to October 2011, two neurologists in the Baptist Health network misdiagnosed patients with various neurological disorders, such as multiple sclerosis, which caused Baptist Health to bill for medically unnecessary services. Although Baptist Health placed one of the physicians at issue on administrative leave in October 2011, it did not disclose any misdiagnoses to the government until September 2012.
"This settlement sends a clear message that health care fraud will not be tolerated in our district, particularly when there is the potential for harm to patients," said U.S. Attorney A. Lee Bentley III for the Middle District of Florida.
The improper conduct at issue in this case included Medicaid patients. Medicaid is funded jointly by the states and the federal government. The state of Florida, which paid for some of the Medicaid claims at issue, will receive $19,024 of the settlement amount.
"Health care providers will not be permitted to provide patients unnecessary medical services and drugs and then pocket the improper payments they receive as a result," said Acting Special Agent in Charge Brian Martens, U.S. Department of Health and Human Services Office of Inspector General. "Our agency is dedicated to investigating health care fraud schemes that divert scarce taxpayer funds meant to provide for legitimate patient care."
The government's investigation was initiated by a qui tam, or whistleblower, lawsuit filed under the False Claims Act by Verchetta Wells, a former Baptist Health employee. The act allows private citizens to file suit for false claims on behalf of the government and to share in the government's recovery. Wells will receive $424,155.
"These health care providers did not only violate the laws of the United States -- they violated the trust placed in them by their patients," said Patrick McFarland, inspector general of the U.S. Office of Personnel Management. "Federal employees deserve health care providers, including hospitals, that meet the highest standards of ethical and professional behavior. Today's settlement reminds all providers that they must observe those standards and reflects the commitment of federal law enforcement organizations to pursue improper and illegal conduct that may put the health and well-being of their patients at risk."
"We have settled because engaging in a potentially lengthy and costly legal argument would not benefit our patients or serve the community," Cindy Hamilton, of Baptist Health, said in a statement. "Health care fraud is a serious matter and one that is not tolerated by Baptist Health. The Department of Justice release acknowledges that: 'The claims resolved by this settlement are allegations only, and there has been no determination of liability.'"
The Justice Department said this settlement illustrates the government's emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Secretary of Health and Human Services Kathleen Sebelius.
Officials said the partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. Officials said one of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $19.1 billion through False Claims Act cases, with more than $13.6 billion of that amount recovered in cases involving fraud against federal health care programs.