DOJ complaint accuses Community Health Network of Medicare fraud

Health

INDIANAPOLIS, Ind.– A complaint by the U.S. Department of Justice (DOJ) accuses Community Health Network of submitting false claims to the Medicare program.

The DOJ says Community violated the Stark Law, which, “prohibits physicians from referring patients to receive ‘designated health services’ payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies,” according to the U.S. Department of Health and Human Services.

The complaint accuses Community of having employment relationship with multiple doctors that did not meet any Stark Law exception. The DOJ says the compensation Community paid to the physicians “was well above fair market value” and claims Community conditioned paying bonuses on physicians achieving a minimum target of referral revenues to the hospital.

“Community received referrals from these physicians in violation of the Stark Law and submitted claims to Medicare knowing that the claims for those referred services were not eligible for payment,” the DOJ said in a release.

Officials say such incidents can threaten patient care as well as drive up Medicare costs.

“We are committed to eliminating these improper inducements and thereby ensuring the Medicare program remains fiscally sound to serve our nation’s senior citizens,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division.

Community Health Network issued this statement:

Community Health Network is committed to upholding the highest regulatory and ethical standards in all our business practices, including physician compensation. We have cooperated fully with the government’s requests leading up to this point, and we are disappointed with their decision. We believe that it is a waste of the government’s time and resources to pursue these meritless claims.

This lawsuit involves certain administrative issues that are completely unrelated to patient care. We are confident that we have complied with the laws and regulations that govern the way we operate our health network. We are committed to fighting these allegations which have no merit.

We are confident that we have complied with the law and regulations that govern the way we pay our physicians for the services they provide to our patients and to the communities we serve – services such as teaching, research, providing education to patients and developing protocols to enhance care delivery.

Community recognizes that physician compensation is very complex and highly regulated. Our physician compensation practices are a key part of our overall compliance efforts. We are confident that we operate in a legally compliant manner. To ensure compliance, as is standard in the industry, Community uses a variety of resources including independent, third parties to evaluate physician compensation to ensure it is fair, as the law requires.

We are proud to provide our patients with convenient access to exceptional healthcare services, where and when they need them—in hospitals, health pavilions and doctor’s offices, as well as workplaces, schools and homes.

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