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Community Health Network accused of filing false Medicare claims

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Posted at 12:36 PM, Jan 07, 2020
and last updated 2020-01-07 12:47:33-05

INDIANAPOLIS — Community Health Network is accused of filing false Medicare claims from doctors who were paid bonuses to provide a certain number of referrals.

The United States has filed a complaint against Community Health Network Inc. under the Stark Law, which says hospitals are prohibited from billing Medicare for services that were referred by a physician which the hospital has an improper financial relationship unless it meets a statutory or regulatory exception. The complaint alleges that the services billed and part of the complaint did not fall under any of those exceptions because the hospital network paid the physicians involved "well above fair market value" and because they paid bonuses for those physicians to achieve a minimum number of referrals, according to a press release issued by the U.S. Attorney's Office.

“Improper financial relationships between hospitals and physicians corrupt clinical decision-making, threaten patient care, and ultimately drive up Medicare costs,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “We are committed to eliminating these improper inducements and thereby ensuring the Medicare program remains fiscally sound to serve our nation’s senior citizens.”

“Our goal at the U.S. Attorney’s Office is to serve the citizens and help ensure safety in their communities,” said U.S. Attorney Josh Minkler for the Southern District of Indiana. “Hospitals are responsible for not only the health and well-being of their patients, but are also required to establish a compliance program in order to protect against improper payments, fraud and abuse as a condition of enrollment in the Medicare program.”

The complaint was initially filed under the qui tam or 'whistleblower provisions' of the False Claims Act, which allows private parties to file a lawsuit on behalf of the U.S. for false claims in order to receive a part of whatever is recovered, according to the U.A. Attorney's Office.

The case is being handled by the Justice Department's Civil Division and the United States Attorney's Office for the Southern District of Indiana.

Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services (HHS), at 800-HHS-TIPS (800-447-8477).

Community Health Network issued the following statement to RTV6 Tuesday afternoon:

"Community Health Network is committed to upholding the highest regulatory and ethical standards in all our business practices, including physician compensation. We have cooperated fully with the government’s requests leading up to this point, and we are disappointed with their decision. We believe that it is a waste of the government’s time and resources to pursue these meritless claims.

This lawsuit involves certain administrative issues that are completely unrelated to patient care. We are confident that we have complied with the laws and regulations that govern the way we operate our health network. We are committed to fighting these allegations which have no merit.

We are confident that we have complied with the law and regulations that govern the way we pay our physicians for the services they provide to our patients and to the communities we serve – services such as teaching, research, providing education to patients and developing protocols to enhance care delivery.

Community recognizes that physician compensation is very complex and highly regulated. Our physician compensation practices are a key part of our overall compliance efforts. We are confident that we operate in a legally compliant manner. To ensure compliance, as is standard in the industry, Community uses a variety of resources including independent, third parties to evaluate physician compensation to ensure it is fair, as the law requires.

We are proud to provide our patients with convenient access to exceptional healthcare services, where and when they need them—in hospitals, health pavilions and doctor’s offices, as well as workplaces, schools and homes."