The Health Alliance of Greater Cincinnati and one of its former member hospitals, The Christ Hospital, will pay $108 million to settle claims that they violated the Anti-Kickback Statute and the False Claims Act.
Federal investiagtors charged the two organizations with paying doctors in exchange for referring cardiac patients to The Christ Hospital in a so-called "pay-to-play" scheme.
According to investigators, The Christ Hospital, a 555-bed acute care hospital in Mount Auburn, Ohio, limited cardiologists' opportunity to work at the Heart Station – an outpatient cardiology testing unit that provides non-invasive heart procedures – to those who referred cardiac business to hospital.
As a part of the scheme, investigators said, the cardiologists whose referrals contributed at least 2 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.
Officials said The Christ Hospital’s use of Heart Station panel time to induce 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. Also, they said, all Medicare and Medicaid claims that The Christ Hospital submitted as a result of the kickback scheme were a violation of the False Claims Act.
"Kickbacks can distort clinical decisions, cause over-utilization, increase costs and threaten the quality of care provided to beneficiaries,” said Daniel R. Levinson, inspector general of the Department of Health and Human Services' Office of Inspector General.
"Healthcare providers should make medical decisions based on the needs of their patients, not on the financial interests of physicians or other providers," said Tony West, assistant attorney general for the Civil Division of the Department of Justice. "We will not allow hospitals to put profits ahead of sound medical decision-making."
The allegations stem from a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act, which allow private parties to file actions on behalf of the United States and share in any recovery. The whistleblower, Harry Fry, a cardiologist who formerly worked at The Christ Hospital, will receive $23.5 million.