According to WTHR, The US Department of Justice filed a complaint against Community Health Network. The complaint stems from the central Indiana health care system submitting claims that were false to the Medicare program. Community Health Network paid physicians referring clients to the hospital who were “well above fair market value.”, claims the DOJ.
DOJ Complaint & Allegations
Physicians received bonuses through Community Health Network, for a certain amount of patients referred stated in the complaint. Knowing those referred to the services were not eligible, Community Health Network still submitted them to Medicare. In a quote from Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division, stated “Improper financial relationships between hospitals and physicians corrupt clinical decision-making, threaten patient care, and ultimately drive up Medicare costs,”. He also stated, “We are committed to eliminating these improper inducements and thereby ensuring the Medicare program remains fiscally sound to serve our nation’s senior citizens.”
Community Health Network Statement
In response to the DOJ complaint, Community Health Network issued this response:
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.
This complaint also brings in accusations of abuse of the Stark Law. The law aims to curb Medicare and Medicaid spending by prohibiting physicians and hospitals from making referrals based on financial self-interest. The law is breached if providers pay doctors above a fair market value which usually is above the 75th percentile. According to the complaint, Community Health Network set salaries in the 90th percentile.
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