Piedmont Healthcare has paid $16 million to settle allegations that it violated the False Claims Act, the Georgia False Medicaid Claims Act, and the federal Anti-Kickback Statute.
Piedmont Healthcare settles false claims allegations for $16 million
June 30, 2020
by John R. Fischer, Senior Reporter
Piedmont Healthcare has agreed to pay $16 million to the Department of Justice and State of Georgia to settle allegations by a whistleblower that it violated the False Claims Act and the Georgia False Medicaid Claims Act.
The Atlanta-based nonprofit healthcare system was accused of improperly billing for cardiac and vascular short-stay admissions and for engaging in certain physician compensation arrangements that violated the Anti-Kickback Statute, according to Moss & Gilmore LLP, an Atlanta and New York-based law firm that represented the unnamed whistleblower.
“The federal government is aggressively pursuing violations of the Anti-Kickback Statute, and upcoding of both inpatients and outpatients,” Raymond L. Moss, a partner at Moss & Gilmore, told HCB News. “Also, COVID-19 will not shield healthcare providers from potential liability under the False Claims Act. Critically the government continues to focus resources to make sure the elderly and critically ill patients are given the appropriate level of care and billing.”
The suit was filed in 2016 against Piedmont Healthcare Inc., Piedmont Hospital Inc., Piedmont Cardiology of Atlanta LLC, and Piedmont Heart Institute Physicians Inc. (“Piedmont").
Among its allegations was that the provider overturned judgements made by its treating physicians numerous times between 2009 and 2013 for procedures to be performed at less expensive outpatient or observation levels of care. It instead billed Medicare and Medicaid for the most expensive inpatient level of care, which in some cases included diagnostic imaging such as ultrasound, nuclear stress tests and echocardiograms, as well as temporary and permanent implants of pacemakers and defibrillators.
Piedmont denies any wrongdoing and says the issue of deciding if a hospital patient should be classified under inpatient status or on observation status was a major challenge for every health system in the country at the time. It also says the government itself has since recognized the confusing standards and instituted, in 2013, a new “two-midnight” rule to provide further clarity.
“During the period in question, Piedmont assigned patient status as best it could, in part with the assistance of an industry-leading third-party vendor that helped interpret these technical definitions,” John Manasso, manager of public relations for Piedmont, told HCB News. “In all cases, our doctors and nurses made their decisions based on the best interest and health of their patients — just like they always have and always will. Our decision to settle is not an admission of liability, simply the best way to end a costly and time-consuming investigation so we can continue to focus on caring for the communities we serve across Georgia.”
The False Claims Act prevents individuals and companies from defrauding the government, and allows individuals with information on false claims or overcharges to come forward. The Georgia False Medicaid Claims Act mirrors the False Claims Act and prohibits any person or entity from submitting a false or fraudulent claim to the state of Georgia, including Medicaid.
The healthcare system was also accused of paying a commercially unreasonable and above fair market value for a catheterization lab partly owned by Atlanta Cardiology Group. The purchase occurred in 2007 when it acquired the physician practice group, and was deemed in the suit to be a violation of the federal Anti-Kickback Statute.
The DOJ awarded the whistleblower a relator’s share of $2,967,400. The action involved claims for retaliatory and discriminatory behavior that Piedmont is alleged to have shown to the whistleblower. This included but was not limited to his or her wages (including front and back pay as well as interest thereon) and benefits and any and all other relief afforded to them under the law. The claims of retaliation were resolved as part of the settlement.
“Billing the government for unnecessary inpatient services wastes precious government resources and taxpayer dollars,” said U.S. Attorney Byung J. “BJay” Pak for the United States District Court for the Northern District of Georgia, in a statement. “All appropriate action will be taken to ensure that beneficiaries of federal healthcare programs received services untainted by overcharges and improper financial incentives.”
All claims in the case have been resolved.
The Atlanta-based nonprofit healthcare system was accused of improperly billing for cardiac and vascular short-stay admissions and for engaging in certain physician compensation arrangements that violated the Anti-Kickback Statute, according to Moss & Gilmore LLP, an Atlanta and New York-based law firm that represented the unnamed whistleblower.
“The federal government is aggressively pursuing violations of the Anti-Kickback Statute, and upcoding of both inpatients and outpatients,” Raymond L. Moss, a partner at Moss & Gilmore, told HCB News. “Also, COVID-19 will not shield healthcare providers from potential liability under the False Claims Act. Critically the government continues to focus resources to make sure the elderly and critically ill patients are given the appropriate level of care and billing.”
The suit was filed in 2016 against Piedmont Healthcare Inc., Piedmont Hospital Inc., Piedmont Cardiology of Atlanta LLC, and Piedmont Heart Institute Physicians Inc. (“Piedmont").
Among its allegations was that the provider overturned judgements made by its treating physicians numerous times between 2009 and 2013 for procedures to be performed at less expensive outpatient or observation levels of care. It instead billed Medicare and Medicaid for the most expensive inpatient level of care, which in some cases included diagnostic imaging such as ultrasound, nuclear stress tests and echocardiograms, as well as temporary and permanent implants of pacemakers and defibrillators.
Piedmont denies any wrongdoing and says the issue of deciding if a hospital patient should be classified under inpatient status or on observation status was a major challenge for every health system in the country at the time. It also says the government itself has since recognized the confusing standards and instituted, in 2013, a new “two-midnight” rule to provide further clarity.
“During the period in question, Piedmont assigned patient status as best it could, in part with the assistance of an industry-leading third-party vendor that helped interpret these technical definitions,” John Manasso, manager of public relations for Piedmont, told HCB News. “In all cases, our doctors and nurses made their decisions based on the best interest and health of their patients — just like they always have and always will. Our decision to settle is not an admission of liability, simply the best way to end a costly and time-consuming investigation so we can continue to focus on caring for the communities we serve across Georgia.”
The False Claims Act prevents individuals and companies from defrauding the government, and allows individuals with information on false claims or overcharges to come forward. The Georgia False Medicaid Claims Act mirrors the False Claims Act and prohibits any person or entity from submitting a false or fraudulent claim to the state of Georgia, including Medicaid.
The healthcare system was also accused of paying a commercially unreasonable and above fair market value for a catheterization lab partly owned by Atlanta Cardiology Group. The purchase occurred in 2007 when it acquired the physician practice group, and was deemed in the suit to be a violation of the federal Anti-Kickback Statute.
The DOJ awarded the whistleblower a relator’s share of $2,967,400. The action involved claims for retaliatory and discriminatory behavior that Piedmont is alleged to have shown to the whistleblower. This included but was not limited to his or her wages (including front and back pay as well as interest thereon) and benefits and any and all other relief afforded to them under the law. The claims of retaliation were resolved as part of the settlement.
“Billing the government for unnecessary inpatient services wastes precious government resources and taxpayer dollars,” said U.S. Attorney Byung J. “BJay” Pak for the United States District Court for the Northern District of Georgia, in a statement. “All appropriate action will be taken to ensure that beneficiaries of federal healthcare programs received services untainted by overcharges and improper financial incentives.”
All claims in the case have been resolved.