A Michigan healthcare system and four of its hospitals have agreed to pay $2.8 million to resolve fraud claims related to a gynecologic oncologist's services and billings, including allegedly unnecessary radical hysterectomies and chemotherapy.
The settlement agreement has been reached between Ascension Michigan, the US Department of Justice (DOJ) and other US agencies, and three whistleblowers — Pamela Satchwell, Dawn Kasdorf, and Bethany Silva-Gomez. These three will now collectively receive $532,000 for their efforts.
One of the facilities involved in the agreement is Ascension Crittenton Hospital in Rochester, Michigan, which was in the news in 2017 for billing allegedly unnecessary lab tests. That hospital paid nearly $800,000 to resolve the allegations, which involved patients who been referred by Farid Fata, MD, and staff physicians in his Michigan-based practice.
Fata, called "Dr Death" by his patient victims, is serving 45 years in federal prison for his role in a separate healthcare scheme that included administering unnecessary chemotherapy and other cancer-related drugs to 553 patients, some of whom did not have cancer.
The latest settlement apparently relates to a different doctor, a gynecologic oncologist, whose name is redacted in the official documents.
The current agreement is "neither an admission of liability by Ascension Michigan nor a concession by the United States that its claims are not well founded," according to the settlement document.
The United States says that from 2011 through 2017, Ascension Michigan "submitted or caused to be submitted" false claims for payment to Medicare, Medicaid, and TRICARE, the Department of Defense healthcare system.
Those claims consisted of professional and facility fees for medical care provided by the gynecologic oncologist, who was under contract with Ascension Michigan during this time.
Specifically, the fees were for: (1) radical hysterectomies that the oncologist performed on women when only a simple hysterectomy was medically necessary; (2) chemotherapy that the oncologist administered or ordered that was not medically necessary; and (3) evaluation and management services by the oncologist that were not performed or not rendered as represented, according to the DOJ.
Ascension Michigan had "concerns" about the care provided by the gynecologic oncologist due to patient complaints and rates of pulmonary embolisms and surgical infections among his patients, says the DOJ. As a result, the organization engaged a third-party doctor to review a sample of the oncologist's patients in 2016.
The review concluded that "for the majority of the radical hysterectomies and chemotherapy performed by Dr [redacted], a less aggressive surgery or medical intervention would have been the standard of care," according to the DOJ.
The United States further contends that Ascension Michigan kept payments from Medicare, Medicaid, and TRICARE related to care provided by the oncologist even though "Ascension Michigan was aware of the standard of care that Dr [redacted] had previously provided."
"Our agency will continue to hold accountable medical providers who perform medically unnecessary procedures and then inappropriately bill federal healthcare programs," said Lamont Pugh, special agent in charge, Health & Human Services' Office of the Inspector General in a press statement.
Ascension Michigan is part of Ascension, a large Catholic healthcare nonprofit with 140-plus locations in 20 states and nearly 150,000 employees, which says it provided $2.4 billion in charity care in fiscal year 2020.
Medscape Medical News © 2021
Cite this: Nick Mulcahy. Hysterectomy, Chemo Fraud Allegations Settled by Hospitals, DOJ - Medscape - Aug 11, 2021.