The Department of Justice has reached a $77.2 million settlement over false claims submitted between an Oklahoma City specialty hospital and physician group.
The agreement announced Wednesday resolves False Claims Act allegations covering Medicare, Medicaid and Tricare claims submitted by the Oklahoma Center for Orthopaedic and Multi-Specialty Surgery, its part-owner and management company, USP, Southwest Orthopaedic Specialists and two physicians.
In exchange for patient referrals, OCOM and USP allegedly gave SOS and certain doctors money, free or reduced price office space, employees and supplies and preferential investment opportunities. The settlement, which does not determine liability, covers conduct that allegedly took place between 2006 and 2018.
“Offering illegal financial incentives to physicians in return for patient referrals undermines the integrity of our healthcare system,” Ethan Davis, acting assistant attorney general with the DOJ’s civil division, said in a statement. “Patients deserve the independent and objective judgment of their healthcare professionals.”
Under the settlement, USP will pay about $61 million to the federal government, $5 million to Oklahoma and $206,000 to Texas, where some of the physicians were located. SOS and two of its physicians, Dr. Anthony Cruse and Dr. R.J. Langerman, will pay $5.7 million to the U.S. and about $500,000 to Oklahoma.
OCOM and SOS have also entered five-year corporate integrity agreements with HHS’ Office of Inspector General. The agreements require OCOM and SOS to maintain compliance programs and hire an independent review organization to assess arrangements entered into by or on behalf of the organizations.
An OCOM spokeswoman said in a statement that the practice has taken numerous steps to strengthen its compliance safeguards and to ensure its programs and staff meet the highest standards of integrity.
“We are a stronger organization today with tighter processes, sharper controls, more stringent compliance, oversight and a culture that supports our values,” she said.
SOS did not respond to a request for comment.
The allegations were brought in a federal qui tam lawsuit filed by a whistleblower, who also alleged claims under the Oklahoma Medical False Claims Act. The whistleblower’s share of the settlement has not yet been determined.