(The following press release from the Justice Department was received by 
TUESDAY, JULY 2, 2013   (202) 514-2007
WWW.JUSTICE.GOV<http://WWW.JUSTICE.GOV> TTY (866) 544-5309 
WASHINGTON - Fifty-five hospitals located throughout twenty-one states have 
agreed to pay the United States a total of more than $34 million to settle 
allegations that the health care facilities submitted false claims to Medicare 
for kyphoplasty procedures, the Justice Department announced today.  
Kyphoplasty is a minimally-invasive procedure used to treat certain spinal 
fractures that often are due to osteoporosis. 
In many cases, kyphoplasty can be performed safely and effectively as an 
outpatient procedure without any need for a more costly hospital admission.  
The settlements announced today resolve allegations that the settling hospitals 
frequently billed Medicare for kyphoplasty procedures on a more costly 
inpatient basis, rather than an outpatient basis, in order to increase their 
Medicare billings. 
"Hospitals that participate in the Medicare program must bill for their 
services accurately and honestly," said Stuart F. Delery, Acting Assistant 
Attorney General for the Civil Division of the Department of Justice.  "The 
Department of Justice is committed to ensuring that Medicare funds are expended 
appropriately, based on the medical needs of patients rather than the desire of 
medical providers to maximize profits." 
The settling facilities, and the amounts they have agreed to pay, 
include the following: 
*       Atrium Medical Center, Middletown, OH, has agreed to pay $4,232,992.50.
*       Altru Health System, Grand Forks, ND, has agreed to pay $1,492,690.
*       Cedars Sinai Medical Center, Los Angeles, CA, has agreed to pay 
*       Des Peres Hospital, St. Louis, MO, has agreed to pay $900,000.
*       Mount Sinai Medical Center, Miami, FL, has agreed to pay $1,846,194.00.
*       New England Baptist Hospital, Boston, MA, has agreed to pay $374,814.48.
*       St. Anne's Hospital, Fall River, MA, has agreed to pay $552,745.
*       The Queen's Medical Center, Honolulu, HI, has agreed to pay 
*       Trover Health System, Madisonville, KY, has agreed to pay $1,162,837.
*       Wayne Memorial Hospital, Goldsboro, NC, has agreed to pay $1,250,000.
*       Twenty-three hospitals affiliated with HCA Inc., Nashville, TN, have 
agreed to pay a total of $7,145,842.72.  These include:  Aventura Hospital & 
Medical Center (Aventura, FL); Capital Regional Medical Center (Tallahassee, 
FL); Coliseum Medical Center (Macon, GA); Coliseum Northside Hospital (Macon, 
GA); Conroe Regional Medical Center (Conroe, TX); Denton Regional Medical 
Center (Denton, TX); Doctors Hospital of Sarasota (Sarasota, FL); Edmond 
Regional Medical Center (Edmond, OK); Fawcett Memorial Hospital (Port 
Charlotte, FL); Fort Walton Beach Medical Center (Fort Walton Beach, FL); 
Garden Park Medical Center (Gulf Port, MS); JFK Medical Center (Atlantis, FL); 
Los Robles Regional Medical Center (Thousand Oaks, CA); North Florida Regional 
Medical Center (Gainesville, FL); Northlake Medical Center (Tucker, GA); 
Oklahoma University Medical Center (Oklahoma City, OK);  Palmyra Medical Center 
(Albany, GA); Redmond Regional Medical Center (Rome, GA); Southwest Florida 
Regional Medical Center (Fort Myers, FL); St. Lucie Medical Center (Port Saint 
Lucie, FL); Summit Medical Center (Hermitage, TN); Sunrise Hospital & Medical 
Center (Las Vegas, NV); and Wesley Medical Center (Wichita, KS).
*       Six hospitals affiliated with Lifepoint Hospitals, Inc., Brentwood, TN, 
have agreed to pay a total of $2,522,502.69.  These include:  Andalusia 
Regional Hospital (Andalusia, AL); Jackson Purchase Medical Center (Mayfield, 
KY); Lake Cumberland Regional Hospital (Somerset, KY); Minden Medical Center 
(Minden, LA); Russellville Hospital (Russellville, AL); and Western Plains 
Medical Complex (Dodge City, KS).
*       Five hospitals affiliated with Trinity Health, Livonia, MI, have agreed 
to pay a total of $3,910,017.53.  These include:  Mercy Medical Center - 
Dubuque (Dubuque, IA); Mercy Medical Center - Sioux City (Sioux City, IA); St. 
Joseph Mercy Hospital (Pontiac, MI); Mercy Health Partners (Muskegon, MI); and 
Mount Carmel New Albany Surgical Hospital (New Albany, OH).
*       Four hospitals affiliated with Morton Plant Mease BayCare Health 
System, Clearwater, FL, have agreed to pay a total of $2,378,325.45.  These 
include:  Morton Plant Hospital (Clearwater, FL); Morton Plant North Bay 
Hospital (New Port Richey, FL); Mease Dunedin Hospital (Dunedin, FL); and Mease 
Countryside Hospital (Safety Harbor, FL).
*       Three hospitals affiliated with Baptist Memorial Health Care 
Corporation, Memphis, TN, have agreed to pay a total of $691,168.  These 
include:  Baptist Memorial Hospital-Golden Triangle (North Columbus, MS); 
Baptist Memorial Hospital-Collierville (Collierville, TN); and Baptist Memorial 
Hospital-Memphis (Memphis, TN).
*       Two hospitals affiliated with Covenant Health, Knoxville, TN, have 
agreed to pay a total of $1,845,641.74.  These include Parkwest Medical Center 
(Knoxville, TN) and Methodist Medical Center of Oak Ridge (Oak Ridge, TN).
*       Two Hospitals affiliated with Bayhealth Medical Center, Newark, DE, 
have agreed to pay a total of $1,115,306.37.  These include Bayhealth Kent 
General Hospital (Dover, DE) and Bayhealth Milford Memorial Hospital (Milford, 
"This office will continue to ensure that sound medical decisions 
determine the ultimate treatment of a patient, not the financial interests of 
hospitals," said U.S. Attorney William J. Hochul, Western District of New York. 
"We will not stand by and allow hospitals to inflate their profits based on 
unnecessary hospital admissions at the expense of the Medicare program or any 
other federal program. The settlements announced today will help maintain the 
integrity of this important program and all government-funded programs." 
"Whenever hospitals knowingly overcharge Medicare, critically needed 
resources are wasted and health costs are driven up," said Daniel R. Levinson, 
Inspector General for the U.S. Department of Health and Human Services. "When 
taxpayers' dollars are threatened, OIG and its federal partners will take 
The Justice Department has now reached settlements with more than 100 hospitals 
totaling approximately $75 million to resolve allegations that they mischarged 
Medicare for kyphoplasty procedures.  In addition to today's settlement, the 
government previously settled with Medtronic Spine LLC, the corporate successor 
to Kyphon Inc., for $75 million to settle allegations that the company 
defrauded Medicare by counseling hospital providers to perform kyphoplasty 
procedures as inpatient rather than outpatient procedures. 
"It has never been more important to protect the Medicare Trust Fund, 
and this includes ensuring that Medicare is not burdened with the high costs of 
medically unnecessary admissions.  The Office of Inspector General will 
continue to ensure that the Medicare Program is protected from fraud, waste, 
and abuse," said Tom O'Donnell, Special Agent in Charge of the Office of 
Investigations of the HHS-OIG New York Regional Office.  "The settlements 
related to kyphoplasty billing that have been reached with over 100 hospitals 
represent one of the largest and most successful multi-party health care 
investigations in the nation." 
All but four of the settling facilities announced today were named as 
defendants in a qui tam, or whistleblower, lawsuit brought under the False 
Claims Act, which permits private citizens to bring lawsuits on behalf of the 
United States and receive a portion of the proceeds of any settlement or 
judgment awarded against a defendant.  The lawsuit was filed in federal 
district court in Buffalo, N.Y., by Craig Patrick and Charles Bates.  Mr. 
Patrick is a former reimbursement manager for Kyphon, and Mr. Bates was 
formerly a regional sales manager for Kyphon in Birmingham, Ala.  The 
whistleblowers will receive a total of approximately $5.5 million from the 
settlements announced today. 
This resolution is part of the government's emphasis on combating 
health care fraud and another step for the Health Care Fraud Prevention and 
Enforcement Action Team (HEAT) initiative, which was announced by Attorney 
General Eric Holder and Kathleen Sebelius, Secretary of the Department of 
Health and Human Services in May 2009. The partnership between the two 
departments has focused efforts to reduce and prevent Medicare and Medicaid 
financial fraud through enhanced cooperation. One of the most powerful tools in 
that effort is the False Claims Act, which the Justice Department has used to 
recover more than $10.7 billion since January 2009 in cases involving fraud 
against federal health care programs. The Justice Department's total recoveries 
in False Claims Act cases since January 2009 are over $14.7 billion. 
The settlements were the result of a coordinated effort among the U.S. 
Attorney's Office for the Western District of New York, the Commercial 
Litigation Branch of the Justice Department's Civil Division, and the 
Department of Health and Human Services' Office of Inspector General and Office 
of Counsel to the Inspector General. 
The claims resolved by these settlements are allegations only, and there has 
been no determination of liability. 
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