The Department of Justice announced Monday that Adventist Health Systems will pay a $115 million settlement to the United States after claims of False Claim Act violations.
According to the claims, Adventist submitted false claims to Medicare and Medicaid for services performed by paying bonuses to physicians who referred the patients to Adventist hospitals. The relationship between physicians and the facilities that they refer patients to is restricted under federal law to ensure patient care is based on medical need and not financial interests.
The settlement also claims that Adventist improperly coded medical claims sent in to Medicare and Medicaid and as a result obtained greater payouts for these services.
“Adventist-owned hospitals, such as Park Ridge, allegedly paid doctors’ bonuses based on the number of test and procedures they ordered,” said Acting U.S. Attorney Jill Westmoreland Rose of the Western District of North Carolina in a press release issued by the U.S. Department of Justice. “This type of financial incentive is not only prohibited by law, but can undermine patients’ medical care. Would-be violators should take notice that my office will use the False Claims Act to prevent and pursue health care providers that threaten the integrity of our health care system and waste taxpayer dollars.”