by Ben Vernia | May 21st, 2010
In a May 21 press release, the Department of Justice announced that the Health Alliance of Greater Cincinnati and its former member hospital, Christ Hospital in Mount Auburn, Ohio, had agreed to pay $108 million to settle allegations of a “pay-for-play” scheme involving cardiology services. According to the press release:
The United States alleged that The Christ Hospital, a 555-bed acute care hospital located in Mount Auburn, Ohio, limited the opportunity to work at the Heart Station – an outpatient cardiology testing unit that provides non-invasive heart procedures – to those cardiologists who referred cardiac business to The Christ Hospital. The government further alleged that cardiologists whose referrals contributed at least two percent of the hospital’s yearly gross revenues were rewarded with a corresponding percentage of time at the Heart Station, where they had the opportunity to generate additional income by billing for the patients they treated at the unit and for any follow-up procedures that these patients required.
The government asserted that The Christ Hospital’s use of Heart Station panel time to induce lucrative cardiac referrals violated the federal Anti-Kickback Statute, which prohibits a hospital from offering or paying, or a physician from soliciting or receiving, anything of value in return for patient referrals. The United States also alleged that the claims The Christ Hospital submitted to Medicare and Medicaid as a result of this illegal kickback scheme constituted a violation of the False Claims Act.
The case was originally brought by a qui tam whistleblower, a cardiologist who formerly worked at Christ Hospital, who will receive $23.5 million of the recovery (approximately 21.75%).
The Department’s press release raised the specter of the hospital’s possible exclusion from federal healthcare programs by not entering into a Corporate Integrity Agreement (CIA):
Because The Christ Hospital declined to enter into a Corporate Integrity Agreement acceptable to the OIG, the OIG did not provide a release of its administrative exclusion authorities and is further evaluating the matter.