Oroville (Calif.) Hospital agreed to pay $10.25 million to resolve allegations it violated the False Claims Act and the Anti-Kickback Statute, according to a Dec. 12 Justice Department news release.
Five things to know
1. The Justice Department alleged that, to increase hospital admissions, Oroville paid kickbacks to its physicians who were responsible for deciding whether an individual should be admitted as inpatients. The physicians allegedly received a bonus based on how many patients they admitted.
2. The Justice Department also alleged that the hospital admitted patients as inpatients when it knew inpatient care was not medically necessary. The hospital then submitted claims to Medicare and Medicaid for inpatient care, which is more expensive. Oroville also allegedly submitted claims to Medicare and Medicaid that included false diagnosis codes for systemic inflammatory response syndrome, which resulted in excessive reimbursement.
3. Oroville Hospital will pay more than $9.5 million to the federal government and more than $730,000 to California as part of the settlement agreement. The hospital also entered into a five-year corporate integrity agreement with the HHS Office of Inspector General.
4. The settlement resolves claims brought under the whistleblower provisions of the False Claims Act. The whistleblower will receive $1.8 million.
5. The claims resolved in the settlement are allegations only, and there has been no determination of liability.