Ascension Michigan and related hospitals, Providence Park Hospital, St. John Hospital and Medical Center, St. John Macomb Oakland Hospital and Ascension Crittenton Hospital (collectively, Ascension Michigan), all located in Michigan, have agreed to pay $2.8 million to resolve claims that they violated the False Claims Act by submitting or causing the submission of false claims for payment to federal healthcare programs related to alleged medically unnecessary procedures performed by a gynecologic oncologist (the “Doctor”). The settlement resolves allegations that, from Feb. 1, 2011, through June 30, 2017, Ascension Michigan knowingly submitted false claims for payment to federal healthcare programs and improperly retained payment for professional and facility fees related to medically unnecessary radical hysterectomies that the Doctor performed, chemotherapy services that the Doctor administered or ordered that were not medically necessary, and evaluation and management services by the Doctor that were not performed or not rendered as represented. The government alleged that Ascension Michigan had concerns about the quality of care provided by the Doctor due to patient complaints and his suspected higher than average rates of pulmonary embolisms and surgical infections. The government further alleged that, as a result of these concerns, Ascension Michigan engaged a third-party doctor to conduct a peer review of a sample of the Doctor’s patients, which found that, for the majority of the radical hysterectomies and chemotherapy performed by the Doctor, a less aggressive surgery or medical intervention would have been the standard of care.
On June 28, 2018, Ascension Michigan made a submission under the Provider Self-Disclosure Protocol of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) related to professional and facility fees it billed to federal healthcare programs for services provided by the Doctor. Though Ascension Michigan initially improperly retained the monies that it collected related to its billings, Ascension Michigan cooperated in the government’s investigation and took active steps to address concerns related to the Doctor by: (i) engaging a third-party doctor
to conduct the peer review; (ii) placing the Doctor on a performance improvement plan; (iii) ending its contractual relationship with the Doctor; and (iv) submitting the self-disclosure.
