The US Department of Justice announced Thursday that Ascension Michigan had agreed to pay $ 2.8 million to settle a lawsuit alleging that the health care system had filed false federal payment claims for alleged medically unnecessary procedures performed by one of its oncologists.
Authorities say the gynecologist-oncologist, whose name is not named because the suit was sealed as part of the settlement, performed “radical hysterectomy and chemotherapy.” A peer review conducted at the request of the hospital found less aggressive surgery or medical interventions to be appropriate.
The Justice Department said the hospital had received complaints from oncologist patients and was aware that the doctor had a higher than average incidence of pulmonary embolism and surgical infections.
The government alleges that Ascension Michigan deliberately continued to file claims for payment in violation of the False Claims Act from February 1, 2011 to June 30, 2017, despite suspicions of an oncologist’s treatment.
“Healthcare providers cannot shirk their obligation to pay government funds due to federal health programs,” she said. US Attorney Saima Mohsin for the Eastern District of Michigan. “We will vigorously pursue those who do not knowingly refund money received for services that were not medically necessary or that were not billed.”
Ascension Michigan, a St. Louis-based subsidiary of Ascension Health, was not available for comment.
According to a Justice Department press release, the healthcare system, which includes Providence Hospital, St. John Hospital and Medical Center, St. John Macomb Hospital in Auckland and Ascension Crittenton Hospital, suspended the doctor’s work while investigating and then fired him.
“Our agency will continue to prosecute health care providers who perform medically unnecessary procedures and then improperly bill federal health programs,” said Commissioner Lamont Pugh III of the Office of the Inspector General of the Department of Health and Human Services. USA. “Working with our law enforcement partners, we will continue to investigate such misconduct to protect beneficiaries and taxpayer-funded health programs serving these beneficiaries.”
The lawsuit came from three oncologist patients – Pamela Sutchwell, Dawn Kasdorf and Bethany Silva-Gomez, who filed under the whistle-blower statute. Former patients will receive a total of $ 532,000 at an estimated $ 2.8 million.
The allegations were investigated by Denise Barnes of the Justice Department’s Commercial Litigation Division, and Assistant US Attorney Caroline Bell-Harbin of the US Attorney’s Office for the Eastern District of Michigan.