Policy: Law

Durant hospital in Oklahoma agrees to settle health care fraud case

By |
Associated Press,Watchdog,Watchdog Blog,Health Care,Waste and Fraud,Follow the Money,Law

DURANT, Okla. (AP) — A hospital in Durant and its parent company have agreed to pay $1.5 million to resolve claims alleging that an otolaryngologist billed the state's Medicaid program for unnecessary sinus surgeries performed on children.

U.S. Attorney Mark Green said the Medical Center of Southeastern Oklahoma and its parent company, Health Management Associates Inc., will pay $1,065,000 to the federal government and $435,000 to SoonerCare, the state's Medicaid program.

"Fraud, such as billing for services that aren't necessary, costs the taxpayers of Oklahoma thousands of dollars," Green said. "The False Claims Act is a valuable weapon in the government's arsenal to combat these types of abuse."

The claims were first raised in a whistleblower lawsuit. The suit alleged that an otolaryngologist performed unnecessary functional endoscopic sinus surgeries on children who did not need the procedures. The suit also claimed that Medical Center of Southeastern Oklahoma billed SoonerCare for hospital services that the doctor did not perform.

The Durant Daily Democrat reports the hospital is denying the allegations.

"We do not believe that the hospital submitted inappropriate claims and we did not admit to any wrongdoing or liability in this case," the hospital said in a statement. "We negotiated the settlement to avoid the potential for long and more costly litigation."

The hospital said the otolaryngologist involved in the case is no longer employed at the medical center.

View article comments Leave a comment