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Health care providers in Cincinnati area to pay $2.6 million to resolve FCA allegations; whistleblowing doctor will receive $468,000

The Health Alliance of Greater Cincinnati, two of its member hospitals (The Fort Hamilton Hospital and The University Hospital), and University Internal Medicine Associates Inc will pay the federal government $2.6 million to settle claims alleging that they violated the Anti-Kickback Statute and the False Claims Act by engaging in a kickback-for-referral scheme, the Department of Justice announced. The allegations resolved by the settlement were initiated by a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act; the whistleblower, Dr. Deborah Hauger, a cardiologist who formerly worked at The Fort Hamilton Hospital, will receive $468,000 as her share of the recovery.

The Fort Hamilton Hospital is a 310-bed hospital located in Hamilton, Ohio. According to the DOJ, the alleged scheme involved the hospital’s desire to expand the scope of its cardiology services to include certain interventional cardiology procedures. Under state law, The Fort Hamilton Hospital could only perform the interventional cardiology procedures if it participated in a particular clinical trial involving those procedures.

The DOJ asserted that University Internal Medicine Associates, a physician group based at The University Hospital in Cincinnati, offered to provide the interventional cardiology coverage that The Fort Hamilton Hospital needed for the clinical trial, but only if the hospital agreed to refer cardiology patients and procedures to the physician group on a preferential basis. In addition, the DOJ contended that the preferential referral arrangements sometimes resulted in patients being transferred to The University Hospital, or being seen by cardiologists with University Internal Medicine Associates, rather than the hospital or cardiologist of their choosing.

“The False Claims Act is a valuable tool in identifying and deterring fraud and abuse in government health care programs,” said William E. Hunt, acting US Attorney for the case in a statement. “The qui tam provisions of the Act are especially important in a case such as this, where the fraud turned on private referral arrangements known only to insiders.”