SAN FRANCISCO >> St. Helena Hospital, an acute care hospital within the Adventist Health System, has agreed to pay the United States $2,250,000 to settle allegations that it submitted false claims to Medicare for certain cardiac procedures and related inpatient admissions, United States Attorney Melinda Haag announced recently.
St. Helena did not admit guilt in agreeing to the settlement.
The settlement resolves allegations that St. Helena Hospital knowingly charged Medicare for medically unnecessary percutaneous coronary interventions during the period Jan. 1, 2008 through July 31, 2011. Percutaneous coronary intervention, commonly referred to as angioplasty, is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. The United States also alleged that St. Helena Hospital unnecessarily admitted angioplasty patients who should have been treated on a less costly, outpatient basis.
This settlement resolves a lawsuit filed in the U.S. District Court for the Northern District of California by Kacie Carroll, a former employee of St. Helena Clearlake Hospital, under the qui tam or whistleblower provisions of the False Claims Act, which permit private citizens to bring lawsuits on behalf of the United States and obtain a portion of the government”s recovery. Carroll will receive $450,000.
Court documents allege the facilities named, which include many regional hospitals in the Adventist system, “have knowingly submitted … false and fraudulent claims to the United States, the State of California and possibly other states” during that period. Other allegations include “services provided pursuant to kickbacks” and overpayments that were retained by the hospitals, the documents state.
Carroll now resides in Texas. She was hired Sept. 1 2010 as director of the Emergency Department at St. Helena Hospital in Clearlake. According to documents submitted to the court, she allegedly observed fraudulent activity and pressure of healthcare providers to admit patients unnecessarily and complained.
She was “constructively discharged on Nov. 1, 2010.
Assistant U.S. Attorney Steven J. Saltiel handled the matter on behalf of the U.S. Attorney”s Office, with the assistance of Michael Zehr and Kathy Terry.
The case is captioned United States ex rel. Carroll v. Adventist Health Systems, et al., Case No. CV-10-4925 DMR. Because of the settlement, the claims resolved remain allegations only. There has been no determination of liability.
