EmCare, an Envision Healthcare company, paid $33 million to resolve alleged illegal remuneration in exchange for hospital referrals to Healthcare Management Association, which no longer exists.
Here are five things to know:
1. EmCare agreed to pay $29.6 million to resolve allegations, stemming from remuneration for the emergency services providers received from HMA between 2008 and 2012. According to the DOJ, EmCare received the compensation for recommending patients be admitted to HMA hospitals on an inpatient basis when their treatment was indicated as outpatient.
2. Since Medicare typically pays three times more for inpatient admissions than outpatient care, the healthcare providers received more for the inpatient admissions. HMA gave bonus payments to EmCare ED physicians that were tied to EmCare retaining existing contracts and new contracts for increasing admissions for ED patients.
3. As part of the settlement, Envision Healthcare entered into a Corporate Integrity Agreement with the DOJ.
4. MEMA physicians Thomas Mason, MD, and Stephen Folstaf, MD, previously supplied ED physicians to two HMA hospitals based in North Carolina; they initiated the quit tam lawsuit against EmCare. They received $6.2 million in connection with the lawsuit under provisions of the False Claims Act that allow whistleblowers to share in the recovery.