More .. they do the crime.. they pay a fine.. and no one does the time

Mississippi hospital whistleblower gets $3.5M in settlement

http://www.wtva.com/content/news/mississippi/story/Mississippi-hospital-whistleblower-gets-3-5M-in/Z92zQL-2K0OXCRzRQCJq2g.cspx#.VWFJt2ECt7g.blogger

JACKSON, Miss. (AP) — A former employee of a Mississippi hospital is getting almost $3.5 million as part of a string of settlements where 18 hospitals in seven states have agreed to pay $20.4 million over allegations they broke federal law by receiving Medicare reimbursements for psychiatric services that were not “medically reasonable or necessary.”

Ryan Ladner worked for Allegiance Health Management at what’s now Merit Health Wesley in Hattiesburg when his lawyer says Ladner saw illegal billing.

As the person who brought the fraud to the attention of the federal government, Ladner is getting 17 percent of the settlement amounts. None of the hospitals admit liability in their settlements. However, LifePoint Hospitals self-reported the practices to the U.S. Department of Health and Human Services in 2011.

Settlement documents indicate Ladner has been pursuing a whistleblower lawsuit in federal court in Arkansas since 2010 against Allegiance, which is based in Shreveport, La. The case remains under seal, though. Whistleblower actions under the False Claims Act are filed under seal with the private plaintiff seeking to recover money on behalf of the federal government.

The plaintiff, called a relator, sends the lawsuit and a statement to federal authorities, who must decide whether to intervene or not. Cases can remain sealed for years while the government investigates, if a judge agrees. It’s unclear if the government intends to intervene against Allegiance. Lawyers for Ladner and Allegiance declined to confirm that the suit exists.

Allegiance denies wrongdoing and still operates outpatient therapy programs at 17 locations in five states, according to its website.

“Allegiance remains confident that the outpatient psychiatric services provided in the IOPs managed or operated by Allegiance were medically necessary and appropriate as has been confirmed by various government contractors and agencies on multiple occasions through audits, surveys and other inquiries,” the company’s lawyer, Michael Schulze, wrote in a statement.

Cliff Johnson, Ladner’s lawyer, said Ladner was hired by Allegiance to serve as program director for its Inspirations outpatient psychotherapy service at what was then called Wesley Medical Center in Hattiesburg. Ladner got the job even though his previous background was in mortgage lending, Johnson said.

“My client is a smart man who takes seriously the responsibilities he’s given,” Johnson said. “As responsible people do, he attempted to educate himself about the legal requirements for billing services provided at Inspirations and the type of patients who qualify for such services.”

The settlements indicate Allegiance would perform the therapy, the hospitals would bill for it, and Allegiance would get either a share of what they collected or a flat fee. The federal government contends the therapy wasn’t eligible for federal reimbursement for one of several reasons — the patient’s condition didn’t qualify, the treatments weren’t provided according to an individual treatment plan, patient progress wasn’t adequately tracked, or the therapy was “primarily recreational or diversional in nature, and was not therapeutic.

The Justice Department said hospitals knowingly submitted improper bills as early as 2005 and continuing into 2013.

“Hospitals that participate in the Medicare program must ensure that the services they provide and bill for are based on the medical needs of patients rather than the desire to maximize profits,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division said in announcing the settlements earlier this month.

Community Health Systems of Franklin, Tennessee, is paying $15.2 million for 15 hospitals, one in Hattiesburg and others that formerly belonged to Health Management Associates, which Community took over.

Since January 2009, the Justice Department has recovered $15.3 billion in cases involving fraud against federal health care programs.

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