A settlement has been reached to resolve False Claims Act allegations against two Southwest Missouri health care providers.
The allegations arose from a lawsuit that claimed Mercy Hospital Springfield and Mercy Clinic Springfield Communities, engaged in improper financial relationships with referring physicians.
According to the U.S. Justice Department, allegedly the Defendants submitted false claims to Medicare for chemotherapy services rendered to patients referred by oncologists whose compensation was based, in part, on a formula that improperly took into account the value of their referrals to an infusion center operated by Mercy.
“When physicians are rewarded financially for referring patients to hospitals or other health care providers, it can affect their medical judgment, resulting in overutilization of services that drives up health care costs for everyone,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable.”
Reportedly, the whistleblower, Dr. Viran Roger Holden, a physician who was employed by one of the Defendants, will receive $5,440,000 from the recovery.
As part of the settlement, the health system did not admit wrongdoing. In a statement issued by Jon Swope, a regional Mercy executive, stated, "we take this situation very seriously."
