Commerce hospital, cardiologist settle Medicare billing case with feds

ATLANTA - The U.S. Attorney's Office in Atlanta says it has reached settlements with Banks-Jackson-Commerce Hospital and Nursing Home Authority (BJC) and Dr. Narasimhulu Neelagaru in a Medicare billing case. The settlement totals more than $500,000.<br /> <br /> "Kickbacks pervert our health care system, which is designed to insure that health care providers make decisions based solely on what is best for the patient," said Sally Quillian Yates, U.S. Attorney for the Northern District of Georgia.<br /> <br /> "The sustainability of the Medicare Trust Fund is dependent, in large part, upon medical facilities and professionals being prudent and responsible in their billing of health care programs," said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. "This settlement demonstrates the OIG's commitment to ensuring that those who bill the government for services do so in a manner that is in accordance with the law."<br /> <br /> The civil settlement resolves the federal government's investigation into BJC's practices related to paying compensation to Dr. Neelagaru for professional services and medical director services that was in excess of fair market value, according to government officials. The alleged period for these improper payments and patient referrals was from 2000-2009. Because of the nature of these payments to Dr. Neelagaru by BJC, the government claimed that BJC received improper payments by the Medicare program for patients referred to BJC by Dr. Neelagaru.<br /> <br /> This settlement also resolves a lawsuit filed by Ralph D. Williams under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the federal government and share in any recovery obtained.<br /> <br /> Williams will receive a share of the settlement payment that resolves the qui tam suit that he filed. The claims settled in the civil settlement are allegations only, and there has been no determination of liability.<br /> <br /> BJC reached its settlement with the government in September 2010, but the case remained under seal pursuant to a Court order until the gpvernment settled with Dr. Neelagaru. In connection with its settlement, BJC entered into a Corporate Integrity Agreement with the Department of Health and Human Services. That agreement imposes certain obligations on BJC to bolster its compliance program, including independent review of BJC's financial arrangements with medical providers who refer patients to BJC.<br /> <br /> BJC paid $329,000 to settle the case and Dr. Neelagaru has agreed to pay $200,000. The settlement resolves claims that BJC improperly billed the Medicare program for certain procedures and services rendered to patients in violation of the Physician Self-Referral Law, commonly known as the Stark Law, and in violation of the Anti-Kickback Statute.