Whistleblower Lawsuit Over Kickback Scheme Settled with Ohio Hospital

Christ Hospital and the Health Alliance for Greater Cincinnati have agreed to settle a whistleblower lawsuit involving allegations of an illegal kickback scheme that defrauded Medicare for an undisclosed amount. 

U.S. prosecutors accused the hospital’s cardiac care center of filing 100,000 Medicare or Medicaid claims that violated federal law, and was looking at charging the hospital and the alliance $11,000 for each claim. Details of the agreement with the government and a former cardiologist are undisclosed, but according to a report by Cincinnati.com, the settlement of the whistleblower lawsuit is said to likely approach or exceed $100 million.

According to federal investigators, the hospital was allotting time to cardiologists in its heart center based on the amount of coronary bypass procedures and the amount of catheter lab revenue that the doctors generated for the hospital. The charges were initially brought in a suit filed by Harry Fry, a former cardiologist at the hospital, in 2003. The U.S. Department of Justice joined the lawsuit in 2008, saying that it had found 100,000 claims filed between 1999 and 2004 that constituted Medicare and Medicaid fraud.

The hospital, which is no longer part of the Health Alliance, has denied the charges, saying that assigning time was not used to encourage doctors to refer patients to the hospital. Hospital officials say they are settling to avoid what could be a multibillion fine by the government, and are not admitting guilt with the settlement.

Whistleblowers who report a false claim against the government may be entitled to 15% to 25% of any money that the government recovers from the offenders under the qui tam provision of the False Claims Act. In return, the whistleblower must be the first to bring the case to the government’s attention, and must not publicize the claim until the DOJ decides to prosecute the claim.