Last week, Parkland Memorial Hospital in Dallas announced an agreement to pay a $1.4 million settlement to the United States Department of Justice over Medicare and Medicaid fraud allegations.
According to a Parkland press release, the settlement is to resolve a whistleblower lawsuit filed in 2010 and unsealed in May 2012. The whistleblower suit claimed that Parkland and physicians at UT Southwestern Medical Center in Dallas falsely submitted Medicare and Medicaid billing claims for rehabilitation consultations that had not been ordered by patients' primary care physicians, and that some procedures occurred without the required supervision of faculty physicians.
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As part of the proposed settlement, Parkland will also enter into a five-year Corporate Integrity Agreement (CIA) with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services. The proposed CIA includes certain requirements in the areas of compliance, ethics, clinical quality and patient safety, and it establishes ongoing and annual reporting procedures. Parkland, however, does not admit liability to these allegations.
"We consider this proposed settlement a fair resolution that allows Parkland to continue moving forward with the improvements we have been making in the areas of quality and patient safety," said Parkland interim Chief Executive Officer Robert L. Smith in a written statement. "We worked directly with the OIG to develop this proposed agreement, and it will be part of our roadmap for sustainable improvements in the areas of quality of care, patient safety and regulatory compliance. We are committed to complying with both the letter and spirit of the CIA's terms through the ongoing operation of our Compliance & Ethics and Quality & Safety programs."
According to the press release, to ensure that those terms are being fulfilled, the proposed CIA requires the engagement of two outside monitoring organizations. Subject to the OIG's approval, Parkland will identify and engage a Billing Independent Review Organization (IRO) within 90 days. The IRO will monitor Parkland's submission of claims for reimbursement from federal healthcare programs. The OIG, meanwhile, will select and Parkland will retain a Quality Review Organization (QRO), which will be responsible for performing reviews of Parkland's clinical quality systems.
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