The United States Attorney’s Office for the Western District of Pennsylvania announced on May 28, 2024 that Penn Highlands Healthcare—a Pennsylvania not-for-profit corporation operating a hospital system in north, central, and western Pennsylvania—and several of its hospitals—including Penn Highlands DuBois, formerly known as DuBois Regional Medical Center—have agreed to pay the United States $735,000 to resolve a lawsuit alleging False Claims Act infringement through the submission of claims to Medicare and Medicaid resulting from violations of the Physician Self-Referral Law.
The Physician Self-Referral Law, commonly known as the Stark Law, prohibits a medical provider from billing Medicare or Medicaid for certain services referred by physicians with whom the hospital has a financial relationship, unless that relationship satisfies one of the law’s statutory or regulatory exceptions. The Stark Law is intended to ensure that medical decision-making is not compromised by improper financial incentives and is instead based on the best interests of the patient.
In this case, the United States alleged that, from July 1, 2009, through June 30, 2012, Penn Highlands DuBois violated the Stark Law by paying improper compensation to referring physician Gary Ott, M.D., and to a physician employed by Women’s Care of Pennsylvania, Dr. Ott’s practice, in the amount of $420,000 under a Consulting, Medical Director and Related Services Agreement for “employment services” allegedly performed before the agreement went into effect, during which time neither physician was employed by Penn Highlands DuBois.
The settlement stems from a whistleblower complaint filed in October 2016 by three medical providers formerly employed by Penn Highlands pursuant to the qui tam provisions of the False Claims Act, which permit private persons, also called relators, to bring a lawsuit on behalf of the government and to share in the proceeds of the suit. The Act also permits the government to intervene and take over the lawsuit, as the government did in this case in regard to some of the relators’ allegations. The relators will receive $154,350 as part of the settlement.
This case was handled on behalf of the government by the U.S. Attorney’s Office for the Western District of Pennsylvania and the Department of Health and Human Services Office of Inspector General.
The case is captioned United States ex rel. Tuesdae Stainbrook, D.O., M.P.H., Mary Simpson, M.B.A., and Jonathan Pope, M.D. at Civil Action No. 1:16-cv-244. The claims resolved by this settlement are allegations only and there has been no determination of liability.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publicly known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
Visit our website or call us toll-free in the United States at 800-295-3959 to be connected with qui tam lawyers (False Claims Act lawyers) in your U.S. state who may assist you with a False Claims Act lawsuit.
Turn to us when you don’t know where to turn.
