Source: Office of United States Attorneys
Seattle – U.S. Attorney Tessa M. Gorman today announced the resolution of a False Claims Act qui tam matter alleging a Tacoma physician billed government insurance programs for medically unnecessary spinal surgeries. CHI Franciscan Health and St. Joseph Medical Center will pay $745,654 to resolve the matter and former Orthopedic Surgeon Kevin Schoenfelder will pay $197,054 to resolve the case.
“Unnecessary surgeries put patients at risk of medical complications,” said U.S. Attorney Gorman. “In this case we are concerned about protecting taxpayer funded health care, but even more concerned that patients may have needlessly suffered when enduring procedures that were more invasive than was necessary.”
According to the settlement agreement, on May 21, 2018, Dr. Daniel Nehls filed a qui tam lawsuit alleging Dr. Schoenfelder had been performing medically unnecessary spinal surgeries, among other allegations. CHI resolved claims that the hospital billed for Dr. Schoenfelder’s performance of spinal surgery at more spinal levels than necessary and medically unnecessary spinal fusions at Tacoma’s St. Joseph Hospital. Dr. Scheonfelder resolved claims pertaining to his performance of allegedly medically unnecessary spinal surgeries. Between January 1, 2013, and June 30, 2018, these surgeries were billed to government health programs when they were not medically necessary. The surgeries were billed to Medicare, TRICARE, and Veterans Affairs.
In resolving the case, neither the doctor nor the hospital and CHI Franciscan are admitting wrongdoing. Each is paying the government health programs the amount that was improperly billed and additional penalties. Additionally, Dr. Nehls, as the relator who reported the false claims, will receive 22% of the payments to the government health programs.
Dr. Schoenfelder retired in 2018 and surrendered his physician license in 2019.
“Health care providers who perform medically unnecessary procedures compromise the integrity of Federal health care programs and expose their patients to potential harm,” said Special Agent in Charge Steven J. Ryan of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “This outcome demonstrates that HHS-OIG along with our law enforcement partners will relentlessly pursue those who abuse taxpayer-supported health care programs.”
“Subjecting veterans to unnecessary medical procedures at the expense of the taxpayer will not be tolerated. Such activities put at risk VA’s ability to provide timely, quality healthcare within the local community,” said Acting Special Agent in Charge Gregory S. Phelan of the VA Office of Inspector General’s Northwest Field Office. “The VA OIG will continue to work with our law enforcement partners to ensure the integrity of VA’s programs and services.”
“This settlement sends a message to doctors that patient safety and the integrity of our healthcare programs, including the Department of Defense’s TRICARE program, are paramount,” said Bryan D. Denny, Special Agent in Charge of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Western Field Office. “DCIS remains committed to working with its law enforcement partners in protecting the integrity of federal healthcare programs, which facilitates an environment for our healthcare providers to be truly focused on quality patient care and safety.”
The settlement resolved a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties known as relators to file suit on behalf of the government for false claims and to share in any recovery. The qui tam suit is captioned United States ex rel. Daniel Nehls v. Catholic Health Initiatives et. al, C18-540-BHS.
The resolution of this case was handled by Assistant United States Attorneys Kayla Stahman and Nickolas Bohl.