Oroville Hospital has agreed swiftly to settle for $10.25 million over allegations of engaging in kickback schemes and submitting false billing claims, according to an announcement by U.S. Attorney Phillip A. Talbert. This hefty sum includes $9,518,954 paid to the federal government and $731,046 to the State of California, aiming to rectify the hospital's alleged misconduct involving the False Claims Act and the Anti-Kickback Statute.
According to the U.S. Attorney's Office release, Talbert stated, "Physicians should make decisions based the best interests of their patients, not their own personal financial interests," condemning practices that threaten the integrity of public healthcare. The settlement also requires Oroville Hospital to enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), which mandates the implementation of a risk assessment and internal review process.
The allegations specify that Oroville Hospital paid kickbacks to its physicians as incentives for the number of patients admitted, which was part of an illegal scheme to falsely elevate hospital admission rates. "Improperly billing federal health care programs depletes valuable government resources used to provide medical care to millions of Americans," said Principal Deputy Assistant Attorney General Brian M. Boynton in the same release, emphasizing the importance of proper use of Medicaid and Medicare funds.
In addition to the financial settlement, the hospital will be monitored by an independent review organization, which will annually assess the medical necessity and appropriateness of certain claims billed to Medicare to prevent further abuse. The agreement follows a whistleblower lawsuit filed by Cecilia Guardiola, who will receive about $1.8 million for exposing these issues.
This case was a collective effort by multiple agencies, including the U.S. Attorney’s Office for the Eastern District of California and the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse. Despite the settlement, it's important to note that the claims resolved are allegations only, and there has been no determination of liability.
For more details on this settlement, readers can visit the Department of Justice website.
