Thirty-two hospitals located throughout 15 states have agreed to pay the United States a total of more than $28 million to settle allegations that the health care facilities submitted false claims to Medicare for minimally-invasive kyphoplasty procedures, the Justice Department announced today. The Justice Department has now reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures.
Kyphoplasty is a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. In many cases, the procedure can be performed safely and effectively as an outpatient procedure without any need for a more costly inpatient hospital admission. The settlements announced today resolve allegations that the 32 settling hospitals frequently billed Medicare for kyphoplasty procedures on a more costly inpatient basis, rather than an outpatient basis, in order to increase their Medicare billings.
“Charging the government for higher cost inpatient services that patients do not need wastes the country’s vital health care dollars,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire to maximize hospital profits.”
The settling facilities and the amounts they have agreed to pay, include the following:
- The Cleveland Clinic in Cleveland, Ohio, has agreed to pay $1.74 million.
- Citrus Memorial Health System in Inverness, Florida, has agreed to pay $2.6 million.
- Cullman Regional Medical Center in Cullman, Alabama, has agreed to pay $350,000.
- Martin Memorial Medical Center in Stuart, Florida, has agreed to pay $2 million.
- MultiCare Tacoma General Hospital in Tacoma, Washington, has agreed to pay $983,000.
- Norwalk Hospital in Norwalk, Connecticut, has agreed to pay $920,000.
- Princeton Community Hospital Association in Princeton, West Virginia, has agreed to pay $1,513,500.
- Sacred Heart Medical Center in Spokane, Washington, has agreed to pay $906,000.
- Sarasota Memorial Hospital in Sarasota, Florida, has agreed to pay $972,000.
- Spartanburg Regional Health Services District Inc. in Spartanburg, South Carolina, has agreed to pay $1.725 million.
- St. Cloud Hospital in St. Cloud, Minnesota, has agreed to pay $500,000.
- Tampa General Hospital in Tampa, Florida, has agreed to pay $2 million.
- Five hospitals affiliated with Community Health Systems Inc., in Franklin, Tennessee, have agreed to pay a total of $3.5 million.These include:Crestwood Medical Center in Huntsville, Alabama; St. Joseph’s Hospital in Fort Wayne, Indiana; Carolinas Hospital System in Florence, South Carolina; Mary Black Health System in Spartanburg, South Carolina; and Trinity Medical Center in Birmingham, Alabama.
- Five hospitals affiliated with Tenet Health Care Corporation in Dallas, Texas, have agreed to pay a total of $2.2 million. These include:East Cooper Medical Center in Mt. Pleasant, South Carolina; North Fulton Hospital in Roswell, Georgia; Providence Memorial Hospital in El Paso, Texas; St. Francis Hospital in Memphis, Tennessee; and Sierra Medical Center in El Paso.
- Five hospitals formerly owned and operated by Health Management Associates Inc., in Naples, Florida, have agreed to pay a total of $2 million.These include:Biloxi Regional Medical Center in Biloxi, Mississippi; Davis Regional Medical Center in Statesville, North Carolina; Lancaster Regional Medical Center in Lancaster, Pennsylvania; Physicians Regional Medical Center in Naples, Florida; and Riley Hospital in Meridian, Mississippi.
- Three hospitals affiliated with BayCare Health System in Clearwater, Florida, have agreed to pay a total of $1.5 million.These include:Winter Haven Hospital in Winter Haven, Florida; St. Joseph’s Hospital in Tampa, Florida; and St. Anthony’s Hospital in St. Petersburg, Florida.
- Two hospitals affiliated with Banner Health in Phoenix, Arizona, have agreed to pay a total of $2.685 million.These include Banner Boswell Medical Center in Sun City, Arizona, and Banner Thunderbird Medical Center in Glendale, Arizona.
“As has been shown throughout this successful investigation, we will never allow hospitals to put profits ahead of patients,” said U.S. Attorney William J. Hochul Jr. of the Western District of New York. “Decisions regarding potential procedures should be made using sound medical judgment only, not with an eye toward increasing Medicare reimbursements. The public should be assured that any hospital involved in improper kyphoplasty billing will be held accountable for its actions.”
In addition to settlements with over 130 hospitals, the government previously settled with Medtronic Spine LLC, the corporate successor to Kyphon Inc., for $75 million to settle allegations that the company caused false claims to be submitted to Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures.
All but three of the settling facilities announced today were named as defendants in a qui tam, or whistleblower, lawsuit brought under the False Claims Act, which permits private citizens to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment awarded against a defendant. The lawsuit was filed in federal district court in Buffalo, New York, by Craig Patrick and Charles Bates. Patrick is a former reimbursement manager for Kyphon, and Bates was formerly a regional sales manager for Kyphon in Birmingham. The whistleblowers will receive a total of approximately $4.75 million from the settlements announced today.
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 $26.7 billion through False Claims Act cases, with more than $16.8 billion of that amount recovered in cases involving fraud against federal health care programs.
The settlements were the result of a coordinated effort among the U.S. Attorney’s Office for the Western District of New York, the Civil Division’s Commercial Litigation Branch and the Department of Health and Human Services’ Office of Inspector General and Office of Counsel to the Inspector General.
The claims resolved by these settlements are allegations only, and there have been no determinations of liability.
A large contingent of nurses from throughout California, clad in red scrubs, marched through the Capital mall in Sacramento yesterday chanting “Workplace violence on the rise, prevention is our key to survive!” as they made their way to the Cal/OSHA public hearing on workplace violence prevention. Once they arrived at the State Resources Building, the nurses, members of the California Nurses Association/National Nurses United, filled the hearing chambers and lined up at the podium to urge that the Cal/OSHA’s Standards Board swiftly adopt the proposed regulations on workplace violence prevention.
The regulations will implement SB 1299, the Workplace Violence Prevention Act, which was authored by former State Senator and current Secretary of State, Alex Padilla, sponsored by CNA/NNU and signed into law by Gov. Jerry Brown last year.
“We are in the midst of an epidemic of violence against nurses,” said RN Bonnie Castillo, CNA/NNU Associate Director, speaking on behalf of over 90,000 registered nurses represented by CNA.
“All the nurses in this room either know someone or have themselves experienced physical violence, threats and assaults on the job. They all experience the fear and frustration of knowing that the procedures their employers have in place are not enough to prevent violent acts from occurring, or to respond adequately when they do. As nurses and health care workers, we are in danger, and we simply cannot wait any longer for the protections we deserve.”
“It is long past time to hold employers in the healthcare industry accountable for preventing and mitigating the risk of workplace violence. We support the proposed regulations because they implement and build upon the strong protections we fought so hard for in SB 1299. We urge speedy passage of the regulations so that we can have comprehensive workplace violence plans in place as soon as possible. Every day we wait is a day that workers are at risk of physical violence, psychological harm, and even death,” said Castillo, who is also the Director of RNRN, the Registered Nurse Response Network, a project of NNU.
CNA board member Katy Roemer, an RN at Kaiser Oakland’s Maternity unit, commended the regulations for covering “healthcare workers in all facilities, outpatient medical offices and clinics, home health care and home-based hospice, paramedic and emergency medical services, field operations, drug treatment programs, off-site operations, and ancillary health care operations such as school nursing and retail clinics.”
Roemer also expressed nurses’ appreciation for Cal/OSHA’s proposing a broad definition of workplace violence, “that incorporates actual acts of violence as well as the threat of violence or use of a dangerous weapon, regardless of whether the employee sustains an injury…The threat of physical force or use of a dangerous weapon can have very real and lasting impacts, such as psychological trauma and stress.”
In her comments, Malinda Markowitz, CNA co-president and RN at Good Samaritan Hospital in San Jose, noted the trend in several states to try to address workplace violence solely by criminalizing the perpetrators, who are for the most part, patients and their loved ones. Nurses support the proposed regulations because they “emphasize prevention over criminalization,” she said. “As nurses, we know that the perpetrators are often suffering from mental instability, addiction, side-effects from medications, or other conditions outside their control. We are patient advocates, and we do not believe that locking up more mentally ill patients is the answer.”
RN Seyma Anajafi, who works at Long Beach Memorial Medical Center, supports the proposed regulations that require “involvement of employees like myself at all stages in developing the workplace violence prevention plan. Without our input, it is likely that many crucial risks and realities would be overlooked for the sake of the employer’s convenience and ease. Requiring input from employees ensures that no risk goes overlooked and that the true experts are consulted in the development of the plan,” said Anajafi.
Noting the packed hearing room, Cal/OSHA Standards Board Chairman David Thomas, said, “It is very moving and astounding to me to have 250 nurses in the hearing room who have all experienced some kind of workplace violence. That is how important these regulations are to protect workers.”
Boardmember, David Harrison, who is also with Operating Engineers Local 3, thanked the nurses for their participation in the regulatory process. “This is the point of having a union and union representation. It is very important to have your voice heard,” he said.
While the overwhelming majority expressed enthusiastic support for Cal/OHSA’s proposed regulations, a spokesperson for the industry lobbying group, the California Hospital Association, argued that “violence can happen anywhere,” and while it can happen in a hospital it isn’t “inherent” to hospitals so it is not something that employers should have to take responsibility for.
“When the hospital industry argues that we need to accept the possibility of violence happening in a hospital and advocates that they not be held accountable for providing a safe therapeutic environment, they are essentially saying they don’t want to do their job,” said Castillo.
“It was pathetic to see the hospital industry spokesperson try to water down the regulations but Cal/OSHA really heard us,” said Ching Cheah, an RN at St. Jude Hospital in Fullerton. “It gave me a strong sense of power to know that CNA/NNU represents us well in legislative and regulatory areas against the hospital industry.”
Today’s public hearing marked the final day of a 45-day public comment period on the proposed regulations related to SB1299. Cal/OSHA will review all the comments and issue the next version of the proposed regulations early next year. The regulations must be finalized and implemented by June 2016.
CNA/NNU sponsorship of SB 1299 and advocacy on behalf of strong violence prevention is a model for the nation. Other National Nurses United affiliates, including the Massachusetts Nurses Association and NNU members in Washington DC are campaigning for similar legislation in response to workplace violence as a serious occupational hazard for RNs and other health care workers.
Here’s a social media wrap up of yesterday’s activities: https://storify.com/nationalnurses/sacramento-hearing-on-workplaceviolence-prevention
To see photos of yesterday: https://www.flickr.com/photos/californianurses/albums/72157660174452054