OK Medical Center Settles False Medicaid Claims for $1.5M; Whistleblower to Get $160K
The Medical Center of Southeastern Oklahoma (MCSO) and its parent, Health Management Associates, Inc., have agreed to pay $1,065,000 to the U.S. and $435,000 to the State of Oklahoma to resolve allegations that the hospital knowingly submitted or caused the submission of false claims to the Oklahoma Medicaid Program, the U.S. Attorney’s Office for the Eastern District of Oklahoma announced last month. MCSO is an acute care hospital located in Durant, Okla. HMA was acquired by Community Health Systems last year.
The settlement announced today resolves allegations that MCSO submitted claims to SoonerCare for surgical procedures performed by Dr. Daniel Castro, and related hospital services that were not medically necessary. The surgical procedures in question were functional endoscopic sinus surgeries (FESS) performed by Dr. Castro on children who were SoonerCare beneficiaries. According to the United States, Dr. Castro performed FESS’s on children that were not medically indicated, and Dr. Castro and the hospital billed SoonerCare for the unnecessary surgeries and related hospital services. The settlement also resolves claims that MCSO billed SoonerCare for hospital services related to FESS’s that Dr. Castro did not actually perform.
The allegations that the government has settled with MCSO and HMA were raised in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act. The Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The whistleblower, Sandra Simmons, will receive $159,750 as part of today’s settlement.
The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments. We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud. Read more about our expertise in False Claims Act cases and how you can take action.