Ontario-based Prime Healthcare Services, 2 doctors settle False Claims cases for $37.5 million – Press Enterprise – California News Times


Los Angeles — based in Ontario Prime Healthcare Service The U.S. Federal Prosecutor’s Office announced on Monday that the hospital system and its two doctors will pay $ 37.5 million to resolve violations of fraudulent claims and California fraudulent claims.

The settlement to settle the two proceedings is a joint resolution with the US Department of Justice and the California Department of Justice.

The federal government and the state of California have signed a settlement agreement with Prime Healthcare Services. Dr. Prem Reddy, Founder and Chief Executive Officer of Prime. According to the prosecutor, intervention cardiologist Dr. Shiva Arnasalam resolved the alleged breach based on the kickback Prime paid to Arnasalam to refer the patient.

Prime includes Prime Healthcare Services Inc., Prime Healthcare Foundation Inc., Prime Healthcare Management Inc., High Desert Heart Vascular Institute, Desert Valley Hospital Inc. It is included.

In a statement sent to City News Service, Prime Healthcare said, “We have completely exempted our liability and reached a settlement without discovering any negligence.” … The allegations did not include patient care, but instead related to a physician’s medical evaluation and appropriate documentation on a limited number of implant claims totaling about $ 200,000. “

Under the settlement agreement, Arnasalam will pay $ 2 million. Reddy has already paid $ 1,775,000 and Prime has paid $ 33,725,000.

The United States will receive a settlement of $ 35,463,057 and California will receive $ 2,036,943. In 2018, Prime and Lady paid $ 65 million to resolve irrelevant allegations of false allegations and overclaims, according to federal prosecutors.

“Physicians have a pledge to do no harm and put the interests of their patients first,” said Tracy L. Wilkison, Deputy District Attorney for the Central District of California. “Kickbacks designed to increase the number of patient referrals disrupt the doctor-patient relationship and unnecessarily waste the country’s medical resources.”

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The settlement resolves the following allegations:

– Prime paid a kickback when he made a large payment to purchase a doctor’s practice and surgery center in Arnasalam. This is because the company wanted a cardiologist to refer the patient to Victorville’s Desert Valley Hospital. The purchase price substantially negotiated by Reddy exceeded the fair market value and was not commercially reasonable. Prime also deliberately overcompensated doctors when HDHVI signed an employment contract with him based on the amount and value of patient referrals to Desert Valley Hospital.

– For nearly two years from 2015 to 2017, HDHVI and Arunasalam used their doctor’s billing number to bill Medicare and Medical for the services provided by Dr. Georgepons. Canceled, Ponce’s billing service with Arnasalam’s billing number was inadequate.

– Certain prime hospitals have filed false claims based on inflated bills for implantable medical hardware with Medi-Cal, the Federal Employee Health Insurance Program, and the Workers’ Accident Compensation Program of the US Department of Labor. Arnasalam was not involved in such an act.

“In our cities and neighborhoods, hospitals are where we go for healing and care. That is, hospitals must be worthy of the trust of the people they serve,” California said. Attorney General Rob Bonta said. “The reconciliation should prioritize interests over people and send a message that plans such as those claimed here are not neglected in an attempt to defraud our Medi-Cal program.”

The Anti-Kickback Act prohibits the provision, payment, solicitation, or receipt of compensation to induce referrals to items or services covered by federal medical programs such as Medicare, Medicaid, and TRICARE. Claims filed in violation of the Anti-Kickback Act may result in liability under the False Claims Act.

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In connection with the settlement, Prime and Lady have signed a five-year contract with the US Department of Health and Human Services Directorate General of Inspection. The agreement requires, among other things, that Prime maintain its compliance program and employ an independent review organization to review arrangements entered into by or on behalf of its subsidiaries and affiliates.

“The Federal Medical Fund is essential to provide the medical services needed to beneficiaries across the country,” said Timothy B. Scheffenska, Special Agent for HHS Inspector General. “Therefore, we address all actions that could endanger the system on which many patients depend, including those alleged in this case. We support these important programs. We will continue to work with federal and state prosecutors to protect taxpayer funds. “

Ontario-based Prime Healthcare Services, 2 doctors settle False Claims cases for $37.5 million – Press Enterprise Source link Ontario-based Prime Healthcare Services, 2 doctors settle False Claims cases for $37.5 million – Press Enterprise



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