Texas Tech heath center settles case.
Texas Tech University Health Sciences Center has been stung in a case similar to a "physicians at teaching hospitals" investigation, even though HHS' inspector general's office two years ago backed away from including Texas hospitals in its nationwide probe, saying the hospitals' fiscal intermediary's guidance was unclear. In a False Claims Act settlement with the federal government, Texas Tech last week agreed to pay $2.3 million to settle allegations that it billed government health programs in 1995 and 1996 for services provided by faculty physicians, when the services were not. The Amarillo hospital settled without admitting guilt. The government's charges stemmed from a 1995 whistleblower lawsuit filed by a dermatology resident, but the whistleblower won't benefit from the settlement. Her suit was dismissed after the U.S. Supreme Court last year ruled that a private individual cannot sue a state body under the False Claims Act.
Antitrust settlement split. Thirty-three states have agreed to a formula on how to split proceeds from a $100 million antitrust settlement with Mylan Laboratories, Pittsburgh. The Federal Trade Commission sued Mylan in December 1998, charging the company and its suppliers with cornering the market on raw materials used to make two anti-anxiety drugs. Thirty-three attorneys general subsequently joined the litigation. A November 2000 settlement agreement requires Mylan to pay a total of $147 million to settle the case, including $35 million to private payers and $12 million for legal fees.
Medicare, Medicaid savings in plan. Medicare and Medicaid programs would recoup or save more than $35 million this year and next if recommendations in four new reports from HHS' inspector general's office were adopted. The reports released earlier this month testify to $19.6 million in federal overpayments for institutionalized mental health patients in New York; $10 million in unallowable costs at a Texas Medicare HMO; $6.1 million in overpayments to hospitals for outpatient laboratory tests for renal disease; and $306,000 in overpayments to Danville, Pa.-based Penn State Geisinger Health Plan. The office recommended legislative changes and new billing system controls.
Genesee to pay $1.3 million. Genesee Hospital, Rochester, N.Y., will pay the federal government $1.3 million to settle charges that the 269-bed hospital routinely submitted laboratory test bills to Medicare without physician authorization from 1992 to 1996. The settlement, announced by the U.S. attorney's office in Rochester, is part of the national investigation dubbed Operation Bad Bundle, which has netted the government $60 million from 257 hospitals since 1996.
Rush Health, affiliates fined. Two-hospital Rush Health Systems, Meridian, Miss., and three affiliates will pay Medicare $1 million to resolve allegations that Rush submitted physicians' provider numbers to Medicare for services delivered by nurse practitioners. The charges stem from a 1997 whistleblower lawsuit filed by a former Rush employee, who will receive $220,500 of the settlement. Rush allegedly submitted physicians' provider numbers without their knowledge. The hospital denied legal guilt.
Bayer settles civil charges. Bayer Corp., New Haven, Conn., will pay $14 million to settle civil charges that it inflated a figure used to set Medicare and Medicaid reimbursement rates. The case is the first of what could be as many as 20 fraud settlements relating to the average wholesale price. By reporting an artificially high price to the government, drug companies allow doctors to profit on their products.
Physician pleads guilty. Monty McClellan, M.D., 60, of Prospect, Ky., pleaded guilty to charges that he wrongly admitted hundreds of patients to a for-profit Chicago hospital, Doctors Hospital of Hyde Park. Many of those patients were homeless people seeking food and shelter, prosecutors said. McClellan and a Doctors Hospital marketing executive were charged earlier this month in connection with the false-admissions scam, which prosecutors said defrauded public and private payers of $3.2 million.