PHYSICIAN REFERRALS LEADS TO $10 MILLION FALSE CLAIMS ACT SETTLEMENT

FROM:  U.S. JUSTICE DEPARTMENT 

Tuesday, March 31, 2015

Ohio-Based Health System Pays United States $10 Million to Settle False Claims Act Allegations

Robinson Health System Inc. has agreed to pay $10 million to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute by engaging in improper financial relationships with referring physicians, the Justice Department announced today.  Robinson is a nonprofit corporation based in Ohio that operates a number of health care facilities in Portage County, Ohio, including Robinson Memorial Hospital.

“The Department of Justice has longstanding concerns about improper financial relationships between health care providers and their referral sources, because such relationships can alter a physician’s judgment about the patient’s true health care needs and drive up health care costs for everybody,” said Acting Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.  “In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable.”

The settlement announced today involved Robinson’s financial relationships with a number of referring physicians that allegedly violated the Anti-Kickback Statute and the Stark Statute, both of which restrict the financial relationships that hospitals may have with doctors who refer patients to them.  These relationships included management agreements that Robinson had with two physicians groups.  These physicians allegedly failed to provide sufficient bona fide management services to have justified the payments that they received.  Robinson disclosed these issues to the government.

“Referrals should be made to the best qualified physicians, and must be based on what’s best for the patient,” said U.S. Attorney Steven M. Dettelbach of the Northern District of Ohio.  “Improper financial relationships between hospitals and referring doctors can lead to clouded judgments, which is why the Department of Justice will continue to police such matters vigorously.”

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act, which prohibits false claims for federal funds, including claims submitted in violation of the Anti-Kickback Statute and the Stark Statute.  Since January 2009, the Justice Department has recovered a total of more than $23.9 billion through False Claims Act cases, with more than $15.2 billion of that amount recovered in cases involving fraud against federal health care programs.

The case was handled by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Northern District of Ohio, and the Department of Health and Human Services’ Office of Inspector General.

COMPANY TO PAY $197,000 PENALTIES, AGREES TO MAKE HEALTH AND SAFETY IMPROVEMENTS

FROM:  U.S. LABOR DEPARTMENT 

Food warehouse avoids potential for catastrophic incident

OSHA says Unicold Corp. put workers at risk in ‘death trap’

HONOLULU — After two years of litigation to correct dozens of hazards that might have had catastrophic effects on its workers and the surrounding community, Unicold Corp. has agreed to make health and safety improvements at its refrigerated food warehouse in Honolulu. The company will also end its fight against $197,000 in penalties assessed in 2013 by the U.S. Department of Labor's Occupational Safety and Health Administration.

A joint inspection by OSHA and Hawaii's Department of Labor and Industrial Relations, Occupational Safety and Health Division found nearly every emergency exit door or route locked, sealed shut, blocked or impossible to use. OSHA found that the violations were a willful disregard of employee safety. Inspectors also identified hazards related to Unicold's use of ammonia as a refrigerant. In all, OSHA identified dozens of violations in February 2013.

"Unicold's use of toxic chemicals such as ammonia created hazards, and also placed workers in danger by blocking virtually every emergency exit to gain additional storage space," said Barbara Goto, acting OSHA regional administrator in San Francisco. "This could have had devastating consequences in a building evacuation, which was a possibility."

Anhydrous ammonia is used as a refrigerant at industrial facilities or warehouses and to produce agricultural fertilizer. A dangerous and corrosive compound, ammonia exposure even in small amounts can cause the eyes, nose and throat to burn. It can also lead to corneal burns or blindness and can cause immediate death.

After Unicold contested the citations, OSHA took all the actions necessary to force the warehouse operator to remedy the serious violations it found. Its pursuit included two years of court filings before the company agreed to make changes and accept its financial penalties.

"The department will not allow Unicold or other employers to allow dangerous conditions that put workers in a potential death trap," said Janet Herold, the department's regional solicitor in San Francisco. "Luck is the only reason that we are not investigating a multi-fatality disaster here. The agency will spend time and resources to protect workers and prevent the intolerable and unacceptable from happening."

Labor Department News Releases Update

Labor Department News Releases Update

RELEASE: NLRB General Counsel Issues Guidance for Representation Case Rule Implementation

RELEASE: NLRB General Counsel Issues Guidance for Representation Case Rule Implementation

OSHA BLAMES U.S. STEEL CORPORATION'S SHORTCUTS FOR DEATHS OF 2 WORKERS

FROM: U.S. LABOR DEPARTMENT

OSHA News Release: [03/24/2015]

Contact Name: Lindsay Williams or Michael D'Aquino

Phone Number: (678) 237-0630

Email: williams.lindsay.l@dol.gov or D'Aquino.Michael@dol.gov 

Release Number: 15-0459-ATL

US Steel Corp.'s safety shortcuts lead to fatal explosion

Time and cost concerns blamed in 2 worker deaths and serious burns to another
FAIRFIELD, Ala. — Like most of us, Leo Bridges and Edward Bryant left for work one day in September 2014, probably thinking about some rest and relaxation when the shift ended. Like many, they figured their managers and employer would ensure they were safe at work. Bridges and Bryant were wrong; they were caught in a fiery explosion in the Flux Building, which U.S. Department of Labor Occupational Safety and Health Administration inspectors said occurred because U.S. Steel Corp. put workers at risk, so as not to slow production at its Fairfield facility.

The three men were opening and closing a malfunctioning valve on a furnace at the Fairfield Works when it erupted, and sent Bridges, Bryant and a third co-worker to the hospital. Bridges, 61, and Bryant, 53, died later due to their injuries. The third man was rushed to a burn trauma unit in critical condition. Fairfield Works is comprised of both steelmaking and finishing facilities. The company has headquarters in Pittsburgh and employs more than 40,000 workers.
"Management knew that attempting to clear the clogged valve while the furnace was still running placed workers at risk, yet they allowed them to do it because they didn't want the production line down for hours," said Ramona Morris, OSHA's area director in Birmingham.

OSHA inspectors determined that the explosion was caused by opening and closing a high-pressure valve that contained oxygen and hydrated lime. The men were doing the work while the furnace was operating, as directed by the department's management.

"Management knew that attempting to operate the valve while the furnace was still running placed workers at risk, yet they allowed them to do it because they didn't want the production line down for hours," said Ramona Morris, OSHA's area director in Birmingham. "This employer chose productivity over the safety of its workers, and two people died as a result of this decision."

OSHA issued the employer a willful citation for not developing and using a procedure to control the hazardous energy to allow workers to operate the valves on the furnace while it is in operation. A willful violation is one committed with intentional, knowing or voluntary disregard for the law's requirement, or with plain indifference to worker safety and health.

Seven serious citations were issued for not developing a procedure to prevent the furnace from releasing hazardous energy while workers performed maintenance; missing exit signs; an improperly installed exit gate; and not training workers to recognize hazardous conditions with the oxygen system. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

HEART MONITORING COMPANY TO PAY $6.4 MILLION TO SETTLE OVER BILLING CHARGES

FROM:  U.S. JUSTICE DEPARTMENT 

Thursday, March 19, 2015

Cardiac Monitoring Company to Pay $6.4 Million for Alleged Overbilling of Government Health Care Programs

BioTelemetry Inc., a heart monitoring company headquartered in Malvern, Pennsylvania, has agreed to pay $6.4 million to resolve allegations made under the False Claims Act (FCA) that its subsidiary, CardioNet, overbilled Medicare and other federal health programs for Mobile Cardiac Outpatient Telemetry (MCOT) services when those services were not reasonable or medically necessary, the Justice Department announced today.

“Billing for a higher-level service that is not necessary to treat a patient’s condition to receive higher reimbursement from federal health care programs will not be tolerated,” said Acting Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.  “Such conduct wastes critical federal health care program funds and drives up the costs of health care for all of us.”

“Today’s settlement is another example of how we will act to stop abusive billing practices and hold companies accountable for conduct that raises everyone’s healthcare costs,” said Acting U.S. Attorney Annette L. Hayes for the Western District of Washington.  “This settlement should send a message to all providers: do not misuse federal billing systems to improperly gouge the healthcare system upon which so many Americans rely.”

An MCOT monitor provides real-time, outpatient cardiac monitoring.  MCOT monitors are worn by patients for a period of time during which the device continuously records the activities of the patient’s heart, including any irregular rhythms or other cardiac event, and transmits data to CardioNet’s diagnostic center using cell phone technology.  Traditional, less expensive event monitors only download patient data periodically over a landline.

The government alleges that CardioNet was aware that MCOT services were not eligible for Medicare reimbursement when provided to patients who had experienced only mild or moderate heart palpitations, since less expensive monitors could effectively collect data about those patients’ conditions.  Nonetheless, CardioNet allegedly submitted claims to Medicare for those patients containing the billing code for the more expensive MCOT services along with an inaccurate diagnostic code that misrepresented the true condition of the patients and their need for MCOT services.

“Sticking taxpayers with a hefty bill for unneeded medical care will never be tolerated,” said Special Agent in Charge Ivan Negroni of the U.S. Health and Human Services, Office of Inspector General (HHS-OIG), Regional Office including Washington.  “Working in close coordination with our law enforcement partners we will tirelessly pursue these suspected violators.”

“Federal employees deserve health care providers, including remote monitoring companies, that meet the highest standards of ethical and professional behavior,” said Inspector General Patrick E. McFarland of the U.S. Office of Personnel Management.  “Today's settlement reminds all providers that they must observe those standards, and reflects the commitment of federal law enforcement organizations to pursue improper and illegal billings that increase the cost of medical care.”

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $23.8 billion through False Claims Act cases, with more than $15.2 billion of that amount recovered in cases involving fraud against federal health care programs.

This investigation was jointly handled by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Western District of Washington and HHS-OIG.