Claris Law Legal Blogging Community

Name:

E-mail:

Phone Number:

Zip Code:

Your Question:

Editor: Mike Bothwell
Profession: Qui Tam Attorney

Category: Settlements and Verdicts

Warren Hospital, headquartered in Phillipsburg, has agreed to pay the United States $7.5 million to settle allegations that it defrauded the federal Medicare program...

The settlement, which was announced in mid-December, resolved two cases brought by Relators under the False Claims Act. The cases alleged that between January 1998 and August 2003, Warren purposefully inflated charges for inpatient and outpatient care in order to receive "outlier" payments from Medicare. Outlier payments are supplemental reimbursement health care providers for cases in which the cost of care was unusually high. The suits also alleged violations of the "Stark laws," charging that the hospital system had submitted claims for Medicare patients referred by physicians with whom it had an unlawful financial relationship.

In addition to the $7.5 million in payment, the settlement calls for Warren to enter into a Corporate Integrity
Agreement ("CIA") with the U.S. Department of Health and Human Services, Office of Inspector General. The OIG uses CIA's to monitor and ensure future compliance with Medicare regulations.

This settlement was the result of a combined effort that involved the Department of Justice's Civil Division, the United States Attorney's Office for the District of New Jersey, Affirmative Civil Enforcement Unit; the United States Attorney's Office for the Eastern District of Pennsylvania; the Department of Health and Human Services, Office of Inspector General and Office of Counsel to the Inspector General; the Centers for Medicare and Medicaid Services; and the Federal Bureau of Investigation.