Record-breaking settlement: Here's why Bon Secours must pay the US government $36.5 million
Greenville's Bon-Secours St. Francis healthcare system agreed to pay the federal government $36.5 million Thursday after it allegedly gave orthopedic doctors bonuses for referring Medicare and TRICARE patients to medical services at the hospital.
The money recovered is touted to be the largest False Claims Act settlement in South Carolina's history in which the Dept. of Justice declined to prosecute.
The settlement sprung from allegations that the hospital violated the False Claims Act, the Federal Stark Law, and the Federal Anti-Kickback Statute, which prohibit medical institutions from incentivizing physicians to refer patients to services like CT scans, ultrasounds and laboratory tests to gain business. It is illegal for hospitals to file medical claims to federal healthcare plans such as Medicare if they are tied to kickbacks.
“Medical providers should base health care decisions on what is best for the patient, and not on financial incentives and related schemes,” U.S. Attorney Adair F. Boroughs for the District of South Carolina said in a press statement.
Bon Secours disputed the allegations. "While we dispute the claims made in this litigation and know that the physician employment arrangements outlined in the case have not been in place for five years, reaching a settlement enables us to place our focus where it belongs ― continuing to compassionately serve patients and communities by providing the high-quality, Mission-centric care that our community has come to expect without the disruption this kind of litigation can pose," the hospital said in a press statement.
Here's what to know about the lawsuit vs. Bon Secours St. Francis healthcare system
The allegations first came to light when Dr. Daniel Lee, an orthopedic surgeon in Piedmont, filed a lawsuit against the hospital July, 2018. The Piedmont physician alleged the kickback scheme began in 2007 and went on for years. About 15 doctors with the Piedmont Orthopedic Associates benefited from the referral bonuses.
Though the DOJ investigated the case, they did not intervene further. Lee and his legal team then filed a lawsuit as a whistleblower. The False Claims Act allows whistleblowers to bring a lawsuit on behalf of the federal government.
As part of the settlement, Lee will be paid $10.2 million from the $36.5 million recovered by the federal government. The hospital system will also remunerate Lee for his attorney’s fees and expenses.
“This case shows that whistleblowers can have a significant impact by stepping forward in the best interests of patients and taxpayers,” Bryan Vroon, Atlanta-based attorney and lead counsel said in a press statement. “I admire Dr. Lee’s courage and determination to not only file the case, but to continue prosecuting the case after the Department of Justice declined to do so. He has great integrity and commitment to compliance with federal laws that protect Medicare, patients, and American taxpayers.”
Devyani Chhetri covers SC politics for the Greenville News. You can reach her at dchhetri@gannett.com
This article originally appeared on Greenville News: Bon Secours to pay $36.5 million to US for alleged fraudulent claims
