Oklahoma Physician, Hospital Settle Fraud Case for $1.5M

State and federal officials say an Oklahoma hospital and physician have agreed to a $1,550,000 payout to settle a health care fraud case.

Sanford C. Coats, U.S. attorney for the Western District of Oklahoma, and Oklahoma Attorney General Scott Pruitt, jointly announced that the Harmon County Healthcare Authority (Harmon Memorial Hospital) and Dr. Akram R. Abraham, of Hollis, Okla., have agreed to settle claims of health care fraud of the Medicare and Medicaid programs.

HCHA and Dr. Abraham have each denied liability, however, according to the joint announcement.

The settlement concludes a lawsuit styled United States of America and State of Oklahoma ex rel. Randy L. Curry v. Harmon County Healthcare Authority, Akram R. Abraham, M.D., P.C., and Akram R. Abraham, M.D., Case No CIV-09-1321-D, filed in Oklahoma City federal court.

Randy L. Curry is from Harmon County and served as the hospital Administrator of Harmon County Healthcare Authority (HCHA) from 2008 to 2009. HCHA operates the Harmon Memorial Hospital in Hollis, Okla.

This suit was brought under the qui tam or whistleblower, provisions of the federal False Claims Act (FCA) and the Oklahoma Medicaid False Claims Act (OMFCA). These Acts allow private citizens with knowledge of fraud to bring civil actions for health care fraud of the federal and state health care programs on behalf of the United States and State of Oklahoma and share in any recovery.

Federal and state officials alleged that from July 1, 2001, through May 30, 2008, both HCHA and Dr. Abraham violated the FCA and the OMFCA by submitting claims, or causing claims to be submitted, to the Medicare and Medicaid programs that violated the federal “Stark” regulations and Anti-Kickback Statute.

Specifically, the government alleged that there was a prohibited contractual relationship between HCHA and Dr. Abraham resulting in excessive remuneration which was not commercially reasonable in the absence of health care referrals and that HCHA and Dr. Abraham made false certifications that the Medicare and Medicaid claims they submitted were in compliance with federal and state regulations.

The alleged improper remuneration included, but was not limited to, free rent of office space, free billing and staff personnel, reimbursement of uncollected accounts receivable, duplicative per encounter payments for emergency room services, and improper payment of locum tenens physician services.

In the settlement, HCHA agreed to pay $550,000 and Dr. Abraham agreed to pay $1,000,000 to resolve the claims. In addition, both HCHA and Dr. Abraham have entered into five year corporate integrity agreements with the U.S. Department of Health and Human Services Office of the Inspector General, which requires additional regulatory compliance reporting and monitoring.

Under the qui tam provisions of the FCA and OMFCA, Randy Curry will receive a share of the settlement proceeds.

Since January 2009, the Department of Justice has recovered over $11.1 billion under the False Claims Act. Of this amount, more than $7.4 billion was recovered in health care fraud matters.

Last year, more than 630 qui tam matters were filed with the Department of Justice – more than in any other year in the history of the FCA and an increase of more than 47 percent since 2009. More than two-thirds of these qui tam cases alleged false claims to government health care programs.

The OMFCA went into effect on Nov. 1, 2007, and its focus is solely on fraud perpetrated against the Oklahoma Medicaid Program. Since its passage, over 351 qui tam cases have been filed on behalf of the State of Oklahoma. The State has received over $63.8 million in civil recoveries resulting from cases alleging fraud on the Oklahoma Medicaid system.

The Oklahoma Attorney General’s MFCU is the only Oklahoma law enforcement agency dedicated to the investigation and prosecution of Medicaid fraud.

This case was investigated by the U.S. Department of Health and Human Services Office of Inspector General Office of Investigations and the Office of Audit Services, and the Oklahoma Medicaid Fraud Control Unit. The case was prosecuted by Executive Assistant U.S. Attorney Bob Troester and Assistant Attorneys General Niki Batt and Lory Dewey.

Source: Oklahoma Attorney General’s Office

Topics USA Fraud Legislation Claims Oklahoma