OKLAHOMA CITY, OK (STL.News) – OKLAHOMA HEART HOSPITAL, LLC, AND OKLAHOMA HEART HOSPITAL SOUTH, LLC (affiliated with Mercy), have agreed to pay $2,800,000 to settle civil claims stemming from allegations that they submitted false claims to Medicaid, announced First Assistant U.S. Attorney Robert J. Troester.
Oklahoma Heart Hospital, LLC, and Oklahoma Heart Hospital South, LLC (collectively “OHH”) are limited liability companies organized in the State of Oklahoma. They own and operate the Oklahoma Heart Hospital and Oklahoma Heart Hospital South, which are located in Oklahoma City.
The United States and the State of Oklahoma allege that from January 1, 2010, through December 31, 2016, OHH caused false claims to be submitted to Medicaid for certain non-emergency prescheduled cardiovascular stent procedures under Diagnosis Related Group Codes 247 and 249. The claims were false because OHH billed the procedures as inpatient services to increase its revenue when the procedures should have been billed and reimbursed as outpatient services.
This $2.8 million settlement resolves part of the allegations filed in a lawsuit by a whistle-blower who formerly worked for OHH. The lawsuit was filed in federal district court in Oklahoma City under the qui tam, or whistle-blower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the United States for false claims and to share in the recovery. The Act also allows the government to intervene in the lawsuit. In this case, the government intervened in the allegations resolved by this settlement, which will provide funds to both the federal government and to the State of Oklahoma. The other allegations raised in the lawsuit will be dismissed as part of the settlement.
In reaching this settlement, OHH did not admit liability, and the government did not make any concessions regarding the legitimacy of the claims. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty involved in litigating the case.
This case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General and Offices of Investigations and Audit Services; FBI Oklahoma City; and the Oklahoma Attorney General’s Medicaid Fraud Control Unit. The case was prosecuted by Assistant United States Attorneys Scott Maule and Ronald R. Gallegos and by Assistant Oklahoma Attorney General Niki S. Batt.
Source: Department of Justice Press Release Dated, Friday, May 31, 2019