Piedmont Healthcare Inc., a hospital system based in Atlanta, will pay $16 million to settle allegations of False Claims Act violations. A whistleblower brought the case under the qui tam provisions of the False Claims Act, alleging Piedmont Healthcare’s practices amounted to Medicaid and Medicare fraud. The whistleblower, a former physician for Piedmont Healthcare, will receive $2,967,400 for the disclosures, according to the Department of Justice (DOJ).
Piedmont Healthcare allegedly inflated the billing of patient procedures for Medicare and Medicaid. Between 2009 and 2013. The DOJ alleges that case managers working at Piedmont allegedly pushed for billing Medicare and Medicaid “at the more expensive inpatient level of care even though the treating physicians recommended performing the procedures at the less expensive outpatient or observation level of care.”
The $16 million settlement also addresses allegations that Piedmont Healthcare paid “a commercially unreasonable and above fair market value for a catheterization lab” partly owned by the Atlanta Cardiology Group.
“We will not tolerate such greed-fueled schemes, which bill taxpayer-funded health care programs and undermined the public’s trust in the healthcare industry,” said Derrick L. Jackson, the U.S. Department of Health and Human Services Office of Inspector General. Jackson said that his office “will continue to aggressively investigate healthcare providers that attempt to boost their profits” in the manner that Piedmont Healthcare allegedly committed.
“Our office will continue to work with our federal partners to ensure that healthcare providers abide by rules that serve as important safeguards for public safety and public resources,” said Georgia Attorney General Chris Carr.