{"id":43405,"date":"2021-07-19T16:09:48","date_gmt":"2021-07-19T23:09:48","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=43405"},"modified":"2021-07-19T16:09:48","modified_gmt":"2021-07-19T23:09:48","slug":"prime-healthcare-two-doctors-agree-to-pay-37-5-million-to-settle-allegations-of-kickbacks","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=43405","title":{"rendered":"Prime Healthcare, Two Doctors Agree to Pay $37.5 Million to Settle Allegations of Kickbacks"},"content":{"rendered":"

LOS ANGELES\u00a0<\/strong><\/span><\/p>\n

\"\"<\/a>One of the largest hospital systems in the nation and two of its doctors will pay $37.5 million to resolve violations of the False Claims Act and the California False Claims Act.\u00a0<\/span><\/p>\n

The settlement<\/a> \u2013 which resolved two cases, one of which the government today learned was unsealed \u2013 is a joint resolution with the U.S. Department of Justice and the California Department of Justice.<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/span>Under the settlement agreement, Arunasalam will pay $2 million. Reddy has already paid $1,775,000, and Prime has paid $33.7 million. <\/span><\/p>\n

The United States will receive $35.4 million of the settlement proceeds, and California will receive $2 million.<\/span><\/p>\n

\"\"<\/a><\/p>\n

In 2018,\u00a0Prime and Reddy paid $65 million<\/a>\u00a0to settle unrelated allegations of false claims and overbilling.<\/span><\/p>\n

\u201cDoctors have a sworn duty to do no harm and to put their patients\u2019 interests first,\u201d said Acting U.S. Attorney Tracy L. Wilkison. \u201cKickbacks designed to increase the number of patient referrals corrupt the doctor-patient relationship and needlessly waste this nation\u2019s health care resources.\u201d<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u201cIn our cities and neighborhoods, hospitals are where we go for healing and care, which means they have to be a place that the people they serve can trust,\u201d said California Attorney General Rob Bonta. \u201cToday\u2019s settlement should send a message that schemes like those alleged here, that put profits before people and seek to defraud our Medi-Cal program, will not be taken lightly.\u201d<\/span><\/p>\n

The settlement resolves allegations that:<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \"\"<\/a> \u00a0Prime paid kickbacks when it overpaid to purchase Arunasalam\u2019s physician practice and surgery center because the company wanted Arunasalam to refer patients to its Desert Valley Hospital in Victorville. <\/span><\/p>\n

The purchase price, which was substantially negotiated by Reddy, exceeded fair market value and was not commercially reasonable. <\/span><\/p>\n

Prime also knowingly overcompensated the doctor when HDHVI entered into an employment agreement with him that was based on the volume and value of his patient referrals to Desert Valley Hospital;<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/p>\n

\"\"<\/a>
Medicare<\/figcaption><\/figure>\n

For approximately two years between 2015 and 2017, HDHVI and Arunasalam used Arunasalam\u2019s billing number to bill Medicare and Medi-Cal for services that were provided by Dr. George Ponce, even though they knew Ponce\u2019s Medicare and Medi-Cal billing privileges had been revoked, and that billing Ponce\u2019s services under Arunasalam\u2019s billing number was improper.<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0Certain Prime hospitals billed Medi-Cal, the Federal Employees Health Benefits Program, and the U.S. Department of Labor\u2019s Office of Workers\u2019 Compensation Programs for false claims based on inflated invoices for implantable medical hardware. Arunasalam was not implicated in this conduct.\u00a0<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by a federal healthcare program, such as Medicare, Medicaid or TRICARE. <\/span><\/p>\n

Claims submitted in violation of the Anti-Kickback Statute may give rise to liability under the False Claims Act.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 In connection with the settlement, Prime and Reddy entered into a five-year Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). <\/span><\/p>\n

The CIA requires, among other things, that Prime maintain a compliance program and hire an Independent Review Organization to review arrangements entered into by or on behalf of its subsidiaries and affiliates.<\/span><\/p>\n

\u201cFederal healthcare funds are integral to the provision of necessary medical services to beneficiaries across the country,\u201d said Special Agent in Charge Timothy B. DeFrancesca of the Office of Inspector General for the U.S. Department of Health and Human Services. \u201cTherefore, we will address any actions, including those alleged in this case, that could compromise the system on which many patients rely. We will continue working with federal and state prosecutors to guard taxpayer funds that support these vital programs.\u201d<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The civil settlement includes the resolution of claims brought under the\u00a0qui tam<\/i>, or whistleblower, provisions of the False Claims Act in two lawsuits filed in federal court in Los Angeles. <\/span><\/p>\n

One suit was filed by Martin Mansukhani, a former Prime executive.\u00a0 <\/span>The second suit was filed by Marsha Arnold and Joseph Hill, who was formerly employed in the billing office at Shasta Regional Medical Center, a Prime hospital in Redding, California.<\/span><\/p>\n

Under the\u00a0qui tam<\/i> provisions of the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. <\/span><\/p>\n

Although the United States did not intervene in these cases, it continued to investigate the whistleblowers\u2019 allegations and helped to negotiate the settlement announced today. Mansukhani will receive $9.9 million as his share of the federal government\u2019s recovery.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

LOS ANGELES\u00a0 One of the largest hospital systems in the nation and two of its doctors will pay $37.5 million to resolve violations of the False Claims Act and the California False…<\/p>\n","protected":false},"author":1,"featured_media":1073,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-43405","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"\nPrime Healthcare, Two Doctors Agree to Pay $37.5 Million to Settle Allegations of Kickbacks<\/title>\n<meta name=\"description\" content=\"LOS ANGELES\u00a0 One of the largest hospital systems in the nation and two of its doctors will pay $37.5 million to resolve violations of the False Claims Act\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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