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Recent Industry News

Healthcare Fraud

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The Department of Justice (DOJ) recently announced their false claims settlement with two southwest Missouri health care providers. Mercy Hospital Springfield and its affiliate, Mercy Clinic Springfield Communities, have agreed to pay $34,000,000 to settle allegations that they violated the False Claims Act by engaging in improper financial relationships with referring physicians. A whistleblower initiated the case and will receive $5,440,000 from the recovery. The case involved allegations that the providers submitted false claims for chemotherapy services to the Medicare Program. The patients receiving the care were referred by oncologists whose compensation was based, in part, on an improper formula. Specifically, the formula improperly took into account the value of their referrals of patients to the infusion center operated by the providers.

The case, United States ex rel. Holden v. Mercy Hospital Springfield, was handled by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Western District of Missouri, and the U.S. Department of Health and Human Services’ Office of Inspector General. The claims settled by this agreement are allegations only, and there has been no determination of liability.

The full press release is available at:

https://www.justice.gov/opa/pr/missouri-hospitals-agree-pay-united-states-34-million-settle-alleged-false-claims-act.

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