Dustin Walsh 
Ascension Health
Ascension St. John Hospital
Ascension Michigan agreed to pay $2.8 million to settle a lawsuit alleging the health system submitted false claims for federal payment for alleged medically unnecessary procedures performed by one of its oncologists, the U.S. Department of Justice announced Thursday.
The government alleges the gynecological oncologist, who is not named because the suit was sealed as part of the settlement, performed “radical hysterectomies and chemotherapy.” A peer review performed at the hospital’s request determined less aggressive surgeries or medical interventions were appropriate.
The Justice Department said the hospital received complaints from the oncologist’s patients and was aware of the doctor’s higher than average rate of pulmonary embolisms and surgical infections.
The government alleges Ascension Michigan knowingly continued to file repayment claims in violation of the False Claims Act from Feb. 1, 2011, through June 30, 2017, despite suspicions about the oncologist’s treatments.
“Healthcare providers cannot avoid their obligation to repay government funds owed to federal healthcare programs,” said Acting U.S. Attorney Saima Mohsin for the Eastern District of Michigan. “We will vigorously pursue those who knowingly fail to repay monies they have received based on services that were not medically necessary or not rendered as billed.”
Ascension Michigan, a subsidiary of St. Louis-based Ascension Health, wasn’t immediately available to comment.
The health system — which includes Providence Hospital, St. John Hospital and Medical Center, St. John Macomb Oakland Hospital and Ascension Crittenton Hospital — suspended the doctor during the investigation and later terminated the doctor, according to a DOJ press release.
“Our agency will continue to hold accountable medical providers who perform medically unnecessary procedures and then inappropriately bill federal healthcare programs,” Special Agent in Charge Lamont Pugh III of the Office of Inspector General for the U.S. Department of Health and Human Services. “Working with our law enforcement partners, we will continue to investigate such misconduct to protect beneficiaries and the taxpayer-funded healthcare programs serving those beneficiaries.”
The suit originated from three of the oncologist’s patients — Pamela Satchwell, Dawn Kasdorf and Bethany Silva-Gomez, who filed under a whistleblower provision in the law. The former patients will receive a combined $532,000 from the $2.8 million settlement.
The allegations were investigated by Denise Barnes of the Justice Department’s commercial litigation branch Assistant U.S. Attorney Carolyn Bell-Harbin of the U.S. Attorney’s Office for the Eastern District of Michigan.
Source link : https://www.modernhealthcare.com/legal/ascension-michigan-pay-feds-28-million-over-alleged-unnecessary-hysterectomies-chemotherapy
