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Christiana Care pays $3.3 million in Qui Tam Suit - Qui Tam Team

Christiana Care pays $3.3 million in Qui Tam Suit

 

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Currently, Delaware’s largest health care provider is continuing to deny any wrongdoing and has stated that the settlement was only to avoid a long and expensive legal battle.

State and Federal prosecutors found that Christiana Care was giving monetary incentives to a group of Wilmington neurologists who would refer their patients to the hospital. The kickbacks were found through overpayments to the doctors for their in-hospital services including reading and interpreting electroencephalograms dating back to 1989. These payments to the group of doctors were found to be significantly higher than other reimbursements for the same services.

“Christiana Care admitted no wrongdoing in this case,” responded Christiana spokesman William A. Schmitt. “We cooperated fully in the investigation and voluntarily provided considerable quantities of records to the government, none of which were found by the Office of the Inspector General to substantiate any of the allegations.”

There was no evidence found that Christiania Care was involved with any claims of improper billing for Medicare or Medicaid programs or services that the hospital did not provide or were not necessary for the patient. Nor were they involved in any inappropriate influence on physician decision making that would compromise patient care in anyway.

The Stark Statute prohibits a hospital from profiting from referrals of patients made by a physician with whom the hospital has contractual relationship. Other state laws include the Anti-Kickback Statute, prohibiting a hospital from paying a physician to induce the physician to make referrals to the hospital. These laws were created to ensure doctors stay focused on the best care and options for the patients rather than financial incentives.

The lawsuit brought against Christiana Care, a Qui Tam suit or commonly known as a whistleblower’s lawsuit, was originally filed in 2005 by a group of doctors with inside information on the fraud at hand. Qui Tam suits allow for those who come forward with information to receive a portion of the government’s settlement. The doctors in this case received a $190,000 share of the settlement.

“Ensuring that public health care dollars are spent in accordance with the law is of importance to all of us, particularly so now as Congress debates health care reform,” Weiss said in a statement. “We are actively working with our investigative partners to ensure Medicare and Medicaid funds are properly spent, and we will continue to aggressively pursue all types of fraud in order to protect the public.”

Delaware Attorney General Beau Biden said the case “sends a strong message that any entity or anyone who attempts to defraud taxpayers by engaging in Medicare/ Medicaid fraud will be held accountable, especially at a time when affordable health care is out of reach for so many of our citizens.”

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