Philadelphia- On 20th August 2020, U.S Attorney William M. McSwain made an announcement saying that Phoenixville Hospital Co., LLC (Phoenixville Hospital) and Phoenixville Hospital accepted to remit 100,000 USD to settle a purported breach of the False Claim Act by resulting in the presenting of falsified forms to the Pennsylvania Department of Human Services, which provides Medicaid to Pennsylvania. Besides, Firstsource Solution USA, LLC, Firstsource Solution Ltd, and its precursor Medassist, Inc. (commonly known as Firstsource Solution), a profit cycle regulation service giver running in Pennsylvania, has accepted to remit 225,000 USD for processing the purported False Claims act on behalf of Phoenixville Hospital.
Phoenixville Hospital, a communal healthcare giver, offers complete medical services, as well as inpatient admissions and emergency room care. Phoenixville Hospital receives patients whose admissions are catered for by the Medicaid program. The United States claims that Phoenixville Hospital caused the submission of falsified allegations to Medicaid to inpatient remedy and /or emergency room drop by charged by Phoenixville Hospital. In certain instances, Phoenixville Hospital purportedly caused the alteration of one of the forms of the Pennsylvania Department of Public Welfare General Assistance, the PA Form 1663 (Employability Assessment Form), to omit the choice for the medical giver to authorize that the self-remitting patient was “Employable.” The United States claimed that, in some instances, the patient, therefore, was not disabled nor entitled to Medicaid coverage for the remedy being charged by the hospital. The T United States further claimed that Phoenixville Hospital resulted in the submission of such forms from January 2008 to February 2012, and a number of these allegations for Medicaid recipients were forged in light of Phoenixville Hospital’s direction.
Firstsource Solution offers profit cycle regulation services to hospitals, helping with submission for identification of qualification of uninsured (self-pay) patients to the Medicaid program. From August 2009 to February 2012, the State claims that Firstsource Solutions deliberately submitted or resulted in the submission of falsified allegations to Medicaid for emergency room visits and /or inpatient therapy charged customers, Phoenixville Hospital.
The charges that were the subject of that day’s settlement were initially claimed in two proceedings filed under the qui tam, or whistleblower, provided by the False Claim Act. The Act allows individual entities to indict for fraud on behalf of the government and to spit the recovered items. The Act, besides, allows the United States to intervene in such activities, as the State earlier did in the 2 whistleblowers proceedings. The whistleblowers in these proceedings would receive a sum of nearly 60,000 of the agreement.
U.S. Attorney McSwain said that his office would investigate credible claims of fraud against the federal healthcare plan., especially when the claimed behavior has potential effects for patient therapy. He added that hospitals that remedy Medicaid victims and the institutions that process Medicaid allegations must be aware of the charges and payment regulations needed by those programs and obey them. Further, he would like to commend the citizens and their attorneys, who originally brought the case to their knowledge.
Special Agent in Charge Maureen R. Dixon for the Office of the Inspector General, U.S. Department of Health and Human Services, said that the False Claim Act’s investigation charges were of primary concern. She added that she would continue collaborating with the U.S. Attorney’s Office to make sure the honesty of the Medicaid and Medicare schemes.
The State’s pursuit of these issues shows its emphasis on fighting healthcare fraud. The false Claim Act is one of the most essential and powerful tools to help with this effort. Alerts and grievances from all sources concerning potential fraud, mismanagement, abuse, and waste can be reported to the Department of Health and Human Services at 1-800-HHS-TIPS (1-800-447-8477).
The investigation for this case was conducted by the Office of the Inspector General, U.S. Department of Health and Human Services. The investigation and the agreement in the U.S. Attorney’s Office were conducted by U.S. Assistant Attorneys Scott W. Reid and Viveca A. Parker, with help from auditor George Niedzwicki. The cases are captioned United States ex rel. Daniel Dimarzio v. Firstsource Solution USA, LLC, Firstsource Solution Ltd, and Medassist, Inc., Civil Action No. 12-1464 and Unites States ex rel. Susan Wilson v. Phoenixville Hospital, et al.., Civil Action No. 15-596.
The allegations settled by the agreement are claims only, and there has been no determination of guilt.
Persons who scheme to commit Health Care Fraud are criminals who break the law. If proven guilty of the offenses, they are severely penalized. Swindling Health Care programs is a serious crime that is harshly penalized under the law. You must seek legal advice or legal representation when indicted for Health Care Fraud or the offenses mentioned above to pursue and protect your rights. The Healthcare Fraud Group proficient team of highly knowledgeable attorneys comprises the best criminal defense attorneys with exceptional experience and provides the best possible service to attain positive results. Our highly conversant team understands the need to prove innocence after accusations of any crime mentioned above. Phone us now at 888-402-4054 for any legal help or representation you may need.