- A Louisville, Kentucky hospital has agreed to pay more than $10 million to resolve allegations it violated the False Claims Act and Anti-Kickback Statute, the U.S. Department of Justice announced Wednesday.
- University of Louisville's Jewish Hospital was accused of submitting false claims for prescription drugs that may not have been medically necessary as well as improper remuneration to Medicare beneficiaries through free blood glucose testing supplies and waiving cost-sharing for insulin. The settlement is not a determination of liability, DOJ said.
- The investigation was the prompted by a whistleblower lawsuit from pharmacist Robert Stone, who will receive $1.85 million as part of the agreement.
The agreement is just the latest to come with health organizations accused of kickbacks or improper claims. Late last week, Sutter Health agreed to pay $30 million to settle claims it paid a group of cardiovascular surgeons in exchange for patient referrals and $15 million for other kickback and Medicare overbilling allegations.
And last month, DOJ said Sanford Health would pay $20 million on allegations a neurosurgeon received illegal payment stemming for his use of implantable devices sold by his physician-owned distributorship. In October alone, the DOJ's civil division said various healthcare organizations agreed to pay nearly $63 million to settle kickback claims.
The agency said the Jewish Hospital case involved allegations the facility knowingly submitted Medicare claims for prescription drugs that did not always obtain a physician's signature, confirm that refills were reasonable or necessary or document that the medicine was delivered.
"Paying for medically unnecessary drugs robs vital government health programs of precious resources and can violate the law," Derrick Jackson, special agent in charge for the HHS Office of Inspector General, said in a statement.
The 462-bed hospital formerly owned by KentuckyOne Health is now part of UofL Health. The University of Louisville bought the facility about three months ago and is now asking the state of Kentucky for a $50 million loan to help turn it around.
Jewish Hospital had been losing money for a while and was up for sale for two years. University of Louisville President Neeli Bendapudi told state lawmakers this week the hospital's closure "would have been catastrophic" according to the Louisville Courier Journal.
HHS has proposed some changes to the Anti-Kickback Statute, intending to facilitate the shift to value-based care by easing barriers to care coordination. Providers mostly approved of the planned amendments, which include new safe harbors and some guidance to clarify when compensation provided to a doctor by another provider must be paid for at fair market value.