Marion County Medical Center agrees to settle fraud allegations

By Jamie Durant

May 19, 2008 (McClatchy-Tribune Regional News delivered by Newstex) --
Marion County Medical Center has entered into a settlement agreement with the federal government to resolve Medicare fraud allegations.

In settling the case, Marion Regional Healthcare System, which operates the center, did not admit liability.

The facility was accused of submitting claims to Medicare for worthless services in October 2006, only months after settling a previous similar case.

The two cases have no bearing on each other and are completely separate, Assistant U.S. Attorney Jennifer Aldrich of Charleston office said.

The settlement agreement announced Monday requires the facility to pay back $36,404 which was originally provided in 2006 to a Medicare beneficiary in the hospital's emergency room.

Both cases were brought to the attention of the federal government via whistle-blowers.

The first case was brought by Dr. Kenneth Orbeck, a family practitioner and a former employee of the medical center. The latest case was presented to government officials by Katherine Pugh, a nurse and a former employee of Marion.

"The whistle-blower filed the suit qui tam action," Acting U.S. Attorney Kevin McDonald said Monday. "(Qui tam action) is a civil suit which can be brought by a person alleging fraud against the federal government."

A qui tam action entitles the whistle-blower to a portion of the proceeds recovered by the suit and attorney fees.

Orbeck was slated to receive $610,083 as his share of the settlement. Pugh will receive $9,101 as her share of the settlement, according to a press release from McDonald.

In the most recent settlement agreement by Marion County Medical Center, CEO Harold Tucker said it was more economical to agree to a settlement than it was to continue fighting the charges against the facility.

"We had already spent more in attorney's fees than the fine, so it just made sense to settle and not fight it," he said.

Tucker said a former employee filed the lawsuit, but the majority of the claims were dismissed.

"There were several assertions made and the government originally requested 60 patient charts from us which we provided," he said. "They dismissed all the charges in the lawsuit and said they did not find a need to do anything."

But, Tucker said, there was one instance where the government felt restitution should be made.

"They felt we should pay back the amount of money originally paid for one patient times three," he said. "That was the fine they put on us for billing what they called worthless charges."

Although Tucker said the problem is not an unusual occurrence in the field of medicine, Aldrich said it is an issue that should not be taken lightly.

"It's really a case where the government felt that the care was not unnecessary -- the care was necessary -- but the care provided was insufficient," she said.

Although the patient did not survive, Aldrich said, it was unclear whether anything could have been done to save her.

"She may not have survived even if she had gotten (proper) care," she said.

The hospital did not admit any wrongdoing in this case or the previous case of Medicare fraud it settled in July 2006. In that case, Marion County Medical Center agreed to pay the United States $3.75 million to resolve fraud allegations involving Medicare, Medicaid and the U.S. military's health-care program.



Newstex ID: KRTB-0314-25416467