Compliance News Roundup: Savvy Patient Blows the Whistle

1. The University of California at Riverside’s Pilot Payroll Certification System Did Not Provide Accountability Over Payroll Charges to Federal Awards (A-04-13-01026) - “The University of California at Riverside’s (the University) prior effort-reporting system did not always provide the information needed to confirm that payroll costs had been appropriately allocated to Federal awards, and its current payroll certification system pilot (pilot PCS) provided less accountability over payroll charges to Federal awards than its prior effort-reporting system. Effort reporting is a person-based methodology that allocates each employee’s reasonable estimate of time worked on all awards and other activities. Specifically, the pilot PCS did not comply with requirements of Circular A-21 and, as designed, limited the ability of the University and the Department of Health and Human Services to provide oversight of these funds. On the basis of our sample, we estimated that the University put at risk $11.7 million in salaries and $5.9 million in associated facilities and administrative costs claimed against National Institutes of Health awards.” Read more here: https://oig.hhs.gov/oas/reports/region4/41301026.asp

2. Federal Jury Finds Shreveport Mental Health Facility Administrator Guilty of Kickback Scheme (February 10, 2017; U.S. Attorney; Western District of Louisiana) - “Tom McCardell, 64, of Lafayette, La., was found guilty of 14 counts of paying illegal kickbacks. After the conclusion of the four-day trial, the jury deliberated approximately four hours before delivering the guilty verdict. United States District Judge Elizabeth E. Foote presided over the trial. According to the evidence presented, from July of 2011 to November 2012, McCardell operated a kickback scheme while he was administrator of Physicians Behavioral Hospital (PBH) in Shreveport. He paid kickbacks to an Alabama resident, who had no medical training or background, to recruit and refer patients to PBH for psychiatric and substance abuse treatment. The hospital would then purchase bus tickets for the patients to travel to PBH in Shreveport. Many of the patients traveled unattended without escort. To avoid detection and suspicion, the defendant arranged for the kickbacks to be issued in the name of the patient recruiter’s son. The defendant also ordered PBH personnel to create an “employee file” in the name of the recruiter’s son in order to provide cover for the illegal kickback arrangement between the defendant and the recruiter. During the scheme, McCardell caused the hospital to pay the recruiter’s son checks totaling $41,000 to which he was not entitled. As a result of the illegal kickback scheme, the hospital billed more than $6.7 million dollars to Medicare and was paid more than $1.2 million dollars.” Read more here: https://www.justice.gov/usao-wdla/pr/federal-jury-finds-shreveport-mental-health-facility-administrator-guilty-kickback

3. Deeper Than The Headlines: Savvy Patient Blows The Whistle - “When we hear of doctors, hospitals and other health care providers settling False Claims Act allegations with the government, we frequently learn that the accusations were first raised by a current or former employee or another healthcare provider such as a physician. However, it does not seem as common to hear of a patient blowing the whistle and being successful in obtaining a portion of the settlement dollars.

But one patient of a Florida Otolaryngologist (ENT) has done just that. Granted, the patient also happened to be a healthcare executive with years of experience in finance, but it was services personally provided to him by the physician’s office that seems to have triggered his lawsuit.” Read more here: http://www.healthicity.com/blog/deeper-than-the-headlines-savvy-patient-blows-whistle