Source: Office of United States Attorneys
SACRAMENTO, California — Oroville Hospital has agreed to pay $10.25 million to the United States and the State of California to resolve allegations that it violated the False Claims Act and the Anti-Kickback Statute, U.S. Attorney Phillip A. Talbert announced today.
The settlement resolves allegations that Oroville Hospital engaged in an illegal kickback and physician self-referral scheme by paying kickbacks to physicians for patients they admitted to the hospital, and that it knowingly submitted false claims to Medicare and Medi-Cal for medically unnecessary hospital admissions and claims that included false diagnosis codes. Oroville Hospital will pay $9,518,954 to the federal government and $731,046 to the State of California.
“Physicians should make decisions based the best interests of their patients, not their own personal financial interests,” said U.S. Attorney Talbert. “Hospitals engaging in kickback schemes betray the trust placed in them by their communities and distort care decisions that should be untainted by illegal kickbacks. This settlement demonstrates my office’s commitment to preserving the integrity of public healthcare programs and ensuring that the well-being of patients remains paramount.”
“Improperly billing federal health care programs depletes valuable government resources used to provide medical care to millions of Americans,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will continue to advocate for the appropriate use of Medicare and Medicaid funds, and we will pursue health care providers who defraud taxpayers by knowingly submitting false claims.”
The settlement resolves allegations that, to increase hospital admissions, Oroville Hospital illegally paid kickbacks to its physicians who were responsible for deciding whether individuals should be admitted as inpatients. These physicians allegedly received a bonus based on how many patients they admitted, according to the settlement agreement. The settlement also resolves allegations that Oroville Hospital admitted patients as inpatients when it knew inpatient care was not medically necessary. Oroville Hospital then submitted claims to Medicare and Medicaid for inpatient care, which is more expensive. Oroville Hospital further allegedly submitted claims to Medicare and Medicaid that included false diagnosis codes for systemic inflammatory response syndrome (SIRS), resulting in excessive reimbursement to the Hospital.
In connection with the settlement, Oroville Hospital entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) that requires, among other requirements, the implementation of a risk assessment and internal review process designed to identify and address evolving compliance risks. The Corporate Integrity Agreement also requires an independent review organization to, among other requirements, annually assess both the medical necessity and appropriateness of select claims billed to Medicare and policies and systems to track arrangements with some referral sources.
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Cecilia Guardiola. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Cecilia Guardiola v. Oroville Hosp., Case No. 2:20-CV-1558 (E.D. Cal.). As part of the settlement announced today, Ms. Guardiola will receive approximately $1.8 million.
Assistant U.S. Attorney Steve Tennyson handled the case for the U.S. Attorney’s Office. The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of California, the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the Department of Health and Human Services, Office of the Inspector General, and the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.