Adventist pays $118.7 million to settle health-care fraud case

As reported in the Orlando Sentinel. 

The Adventist Health System, one of the largest health-care systems in the country, which includes Florida Hospital Medical Group, settled a fraud case with the U.S. government and four states involving illegal physician referrals to its hospitals and fraudulent Medicare and Medicaid reimbursements. The settlement was for $118.7 million. According to the Sentinel the settlement is nearly double the next largest settlement of this kind involving North Broward Hospital District. Adventist is owned by the 7th Day Adventist church.

Adventist Health System released a statement calling their actions “oversights” and stating that the settled claims are allegations only and no liability was determined.

The allegations stem from two whistle-blower lawsuits filed in 2012 and 2013 by employees and a former Adventist Health systems senior health-care executive.

The complaints allege that Adventist initiated a corporate policy that directed its hospitals to purchase physician practices and group practices or employ physicians in their surrounding areas in order to control all patient referrals in those locations. Adventist hospitals allegedly provided excessive compensation, perks and benefits to the physicians. The lawsuits allege that to conceal this and avoid refunding payments, the health system then falsely said that the services identified in its annual cost reports were in compliance with the federal law.

“Would-be violators should take notice that my office will use the False Claims Act to prevent and pursue health care providers that threaten the integrity of our healthcare system and waste taxpayer dollars,” Acting U.S. Attorney Jill Westmoreland Rose of the Western District of North Carolina, said in a statement.

Originally Published  September 23, 2015.

Editor: Although the publication date of an article may not be current the information is still valid.

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APRA’s response, as published in the Orlando Sentinel October 2, 2015:

by Rod Baker for APRA

In the Sept. 23 Sentinel it was reported that Florida Hospital Medical Group, owned by the Adventist Health System, was charged with illegally paying physicians to refer patients to their hospitals. Lawsuits filed by the U.S. government and four states also alleged that the hospital system obtained millions of dollars in fraudulent Medicare and Medicaid reimbursements as a result. Adventist is owned by the Seventh-day Adventist Church.

A total payment of $118.7M, less than one quarter of the net income that Adventist earned in 2013, was agreed to in settlement. The medical group said that the claims are allegations only, and the reimbursements in question were due to “oversights”, but in 2013 Florida Hospital also battled fraud charges for Medicare overbilling and repaid nearly $3 million to the federal government.

This organization has allegedly perpetrated ongoing and systematic fraud against the federal government and taxpayers are the victims. It has also placed patients at risk when it allegedly paid doctors to refer them to hospitals in its group, since the patients may have received better treatment elsewhere.

But where is the public outcry?

Such apathy is symptomatic of a citizenry which has simply given up on a health care system that is in ruins.

Fraud is reflective of moral bankruptcy. How can people be expected to entrust their lives to a health care institution if it  would place them at risk in order to benefit financially? And it’s not just patients who would suffer. The employees of this organization, which is the third largest non-profit health system in the country, must surely be demoralized, knowing that they are working for a hospital group which is developing a reputation for illegal activities.

We depend on our hospitals to treat patients safely, and to the highest medical and ethical standards. It is not enough for a medical group, especially one owned by a religious organization, to receive what amounts to a slap on the wrist for engaging in ongoing illegal activity. There must be more serious consequences, not just for the corporation itself but also for those in charge, that will discourage others who would do the same.

Community leaders in areas served by Florida Hospital should demand that its CEO, and any other responsible executives, be held accountable for their actions. Anything less would only encourage harmful, illegal activity that threatens the public and increases the cost of health care.