Houston medical center pays over $21M to settle alleged claims of falsely billing Medicare
HOUSTON - A Houston medical center has agreed to pay more than $21 million to settle claims that the company allegedly improperly billed Medicare, said officials.
According to a release, Cornerstone Healthcare Group Holding Inc. and CHG Hospital Medical Center LLC. doing business as Cornerstone Hospital Medical Center (CMC), which is located in Houston, agreed to pay the United States $21,637,512 to resolve claims saying the company improperly billed Medicare, announced U.S. Attorney Alamdar S. Hamdani.
"Taking advantage of the elderly and infirm is disgraceful," said Hamdani. "When providers accept federal funds for reimbursement, they have a duty and responsibility to provide the necessary and best care possible to the patient. As one of the largest of its kind in our district, this settlement shows our commitment to protecting our most vulnerable citizens and the integrity of the Medicare system."
SUGGESTED: Georgia woman who lost toe after pedicure says she's now 'a walking PSA': What you need to know now
A few of the alleged claims were turned in for unauthorized services, services not provided, and services deemed so inadequate they were considered worthless.
Cornerstone Medical Center was previously a long-term acute care facility operating as a long-term hospital. The facility provided extended medical rehabilitative care to people who qualified as clinically complex and had multiple acute or chronic conditions.
CHG Holding operates specialty hospitals throughout the nation, including Cornerstone Medical Center.
An investigation started on CMC when a whistleblower lawsuit was filed under seal on Sept. 28, 2018. The person who filed the suit worked at Cornerstone Medical Center's long-term care facility and during their employment, they say to have witnessed unlicensed, unauthorized students of rs. Jorge Guerrero, Joel Joselevitz and Joseph Varon giving medical procedures. These services were then fraudulently billed to Medicare.
Also, CMC submitted claims for payment for services certain physicians allegedly gave but records showed those physicians were out of the county and could not have performed those services.
The investigation further determines from Jan. 1, 2012 through Dec. 31, 2018, Cornerstone Medical Center billed services not supported by the patients' diagnosis or medical records. They also billed for services either not performed or were so inadequate they were worthless, and in some cases, resulted in harm to the patients.
MORE: A third of US parents give fever reducing meds to their kids when it’s not needed
Reports say the claims for payment to Medicare for those services were deemed fraudulent and submitted in violation of federal law.
"Submitting improper claims to Medicare compromises the financial security of the program and wastes valuable taxpayer dollars," said Acting Special Agent in Charge Korby R. Harshaw of Department of Health and Human Services - Office of Inspector General (DHHS-OIG). "We will continue to work alongside our law enforcement partners to protect the integrity of federal health care programs and to hold bad actors who exploit them accountable."
RELATED: Male contraception showed promise in study
"This $21.6 million settlement by Cornerstone Healthcare Group Holding is one of the largest civil healthcare fraud settlements FBI Houston has seen, and we work a lot of healthcare fraud cases. I hope this case sends a message to other healthcare providers who think they can get away with similar fraud," said FBI Special Agent in Charge James Smith. "Not only did Cornerstone Healthcare bilk the Medicare program out of millions of dollars, it also took advantage of its patients who were unknowingly used for its scam. These patients trusted their doctors and healthcare providers and ultimately received little to no care. At the end of the day, health care fraud affects everyone. It raises our health insurance premiums and exposes patients to worthless and unnecessary medical procedures. I’m proud of the work our FBI Houston Healthcare Fraud Task Force has done."
Under the False Claims Act, a private party known as a relator can file an action on behalf of the United States and receive a portion of the recovery. In this case, the relator will receive $4,327,502.