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$1.6 Million Settlement for Submitting False Claims for Medicare Services

April 12, 2017

Oklahoma City, Oklahoma –NORMAN REGIONAL HOSPITAL AUTHORITY d/b/a NORMAN REGIONAL HEALTH SYSTEM; GREG TERRELL; CHADWICK WEBBER, M.D.; MERL KARDOKUS, M.D.; RICK WEDEL, M.D.; GAUTHAM DEHADRAI, M.D.; BARBARA LANDAAL, M.D.; and SANJAY NAROTAM, M.D., have agreed to pay $1,618,750 to the United States to settle civil claims stemming from allegations that the hospital submitted false claims to Medicare, Mark A. Yancey, United States Attorney for the Western District of Oklahoma, announced April 11, 2017.

Norman Regional Hospital Authority d/b/a Norman Regional Health System (“Norman Regional”) operates Norman Regional Hospital (the “Hospital”), which provides radiological and other services to patients in Norman, Oklahoma. Greg Terrell is a former Hospital administrator employed by Norman Regional, and the physicians are radiologists employed by Norman Regional (collectively the “Individuals”).

Norman Regional previously employed radiological practitioner assistants (“RPAs”) in its radiology department. RPAs are not physicians, and the services RPAs provide to Medicare beneficiaries cannot be billed to Medicare unless done under the appropriate level of supervision by a physician. There are certain radiological diagnostic services that require “personal” supervision. This means that a physician must be in the room supervising the RPA when the RPA performs the service. If a physician is not in the room, the service cannot be billed to Medicare.

John Benson, CEO of Verisys says, “The unauthorized practice of medicine is costly and endangers patient safety. Verisys’ health care data and its data solutions can make a huge system-wide impact on these major health care system flaws.”

The United States alleges that from January 1, 2008, through September 30, 2016, Norman Regional and the Individuals submitted, or caused to be submitted, false claims for payment to Medicare for radiological services performed by RPAs without the proper supervision by a physician. Specifically, the RPAs performed radiological services that required “personal” supervision, but a physician was not in the room supervising the RPA when the service was performed.

After being notified of the allegations, Norman Regional cooperated with the United States’ investigation.

In order to resolve the United States’ allegations, Norman Regional and the Individual Defendants have agreed to pay $1,618,750.

The settlement resolves allegations filed in Federal District Court in Oklahoma City by Dr. Lance Garber, a physician formerly employed by Norman Regional as a radiologist. This qui tam, or whistleblower, suit under the False Claims Act permits private individuals to sue on behalf of the government for false claims and to share in the recovery. The Act also allows the government to intervene in the lawsuit, which the government did in this case.

In reaching this settlement, Norman Regional did not admit liability, and the government did not make any concessions regarding the legitimacy of the claims. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty involved in litigating the case.

This case was investigated by the United States Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. The case was prosecuted by Assistant United States Attorneys Ronald R. Gallegos and Scott Maule.

https://www.justice.gov/usao-wdok/pr/oklahoma-hospital-former-hospital-administrator-and-physicians-agree-pay-1618750-settle

Juliette WillardWritten by Susen Sawatzki
Healthcare Industry Expert
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