Several high-profile whistleblower cases have reached settlements with the federal government in the last three months, with some physicians taking home millions as part of the agreements.
Six whistleblower cases totaling more than $82 million:
1. Renton-based Providence Health & Services Washington will pay $22.7 million to resolve allegations it defrauded federal healthcare programs with medically unnecessary spine surgeries. The Justice Department learned about the allegations when the former neurosurgery director at one of Providence's hospitals filed a whistleblower complaint under the False Claims Act complaint against the health system. The whistleblower will receive $4.2 million of the settlement.
2. Anesthesia management services company Care Plus Management and its founders will pay $7.2 million to settle illegal kickback and false claims allegations. The company's founders allegedly convinced ASC physician-owners to award exclusive contracts in exchange for partial ownership in Care Plus anesthesia entities that would service the surgery centers. The whistleblower will receive more than $1.3 million from the settlement.
3. Boston-based Massachusetts General Hospital agreed to pay $14.6 million to settle a whistleblower lawsuit that alleged it violated federal regulations when surgeons left procedures to trainees because they were performing multiple cases. An anesthesiologist at MGH filed a whistleblower report when she left the hospital in 2015.
4. Tampa, Fla.-based Physician Partners of America, its founder and its former chief medical officer will pay $24.5 million to settle alleged violations of the False Claims Act. PPO allegedly billed federal healthcare programs for unnecessary testing and services, illegally paid physician employees 40 percent of the profits from the unnecessary services and made a false statement in connection with a $5.9 million Paycheck Protection Program loan. The settlement resolves claims brought under the whistleblower provisions of the False Claims Act by five current or former PPOA employees, three of whom are physicians.
5. Cardinal Health agreed to pay $13.1 million to settle claims it paid illegal kickbacks to physician practices, and about $2.6 million of the settlement will go to the whistleblowers. The pharmaceutical distributor is accused of paying upfront discounts to physician practice customers that were not attributable to identifiable sales or were rebates the customers had not earned.
6. Tri-State Specialists in Sioux City, Iowa, will pay $612,501.44 to resolve fraudulent billing allegations related to cosmetic procedures performed by a plastic surgeon. The group allegedly billed for procedures that aren't reimbursable by federal healthcare programs and claimed they were medically necessary when they were not. A whistleblower will receive a portion of the recovery.