MICHIGAN — Ascension Michigan and related hospitals have agreed to pay $2.8 million to resolve claims that they violated the False Claims Act by submitting or causing the submission of false claims for payment to federal health care programs.
It’s related to alleged medically unnecessary procedures performed by a gynecologic oncologist, according to a news release Thursday.
“When hospitals receive payment from federal health care programs for medically unnecessary surgical procedures, they cannot simply retain those payments; they have an obligation to return them,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “We will continue to ensure that taxpayer funds are used appropriately for the important programs that they support.”
The settlement announced Thursday resolves allegations that – from Feb. 1, 2011, through June 30, 2017 – Ascension Michigan knowingly submitted false claims for payment to federal health care programs and improperly retained payment for professional and facility fees related to medically unnecessary radical hysterectomies that the doctor involved performed.
There were also chemotherapy services that the doctor administered or ordered that were not medically necessary, as well as evaluation and management services by the doctor that were not performed or not rendered as represented.
The government alleged that Ascension Michigan had concerns about the quality of care provided by the doctor due to patient complaints and his suspected higher than average rates of pulmonary embolisms and surgical infections.
Further allegations say that, as a result of these concerns, Ascension Michigan engaged a third-party doctor to conduct a peer review of a sample of the doctor’s patients, which found that for most of the radical hysterectomies and chemotherapy performed by the doctor, a less aggressive surgery or medical intervention would have been the standard of care.
“Health care providers cannot avoid their obligation to repay government funds owed to federal health care 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.”
Though the health system initially improperly retained the monies it collected related to its billings, Ascension Michigan did cooperate with the government’s investigation and took active steps to address concerns related to the doctor, according to the U.S. Department of Justice.
It did so by using a third-party doctor to conduct the peer review, placing the doctor involved on a performance improvement plan, ending its contractual relationship with the doctor and submitting the self-disclosure.