INDIANAPOLIS (WTHR) - IU Health and HealthNet Inc will pay $18 million to settle a whistleblower lawsuit involving kickbacks and false claims, according to Indiana Attorney General Curtis Hill.
The Medicaid fraud case against Indiana University Health and HealthNet alleges the companies violated the federal Anti-Kickback Statute, the federal False Claims Act and the Indiana False Claims Act. The Indiana AG’s office says IU Health gave an interest-free line of credit to HealthNet. A release from the AG’s office says the line of credit, is alleged to “induce HealthNet to refer its obstetrics and gynecology patients to IU Health’s Methodist Hospital.”
13 Investigates talked with the whistleblower in this case in 2015. Information from Dr Judith Robinson, who was the medical director of maternity programs at IU Methodist and HealthNet Clinics, prompted the government’s original $100 million lawsuit.
She said IU Health and HealthNet put low-income, expectant mothers’ and babies’ health at risk by not giving them proper doctors care. Robinson said, instead, the women were treated by midwives with less training at partner HealthNet Clinics. She claimed the companies billed Medcaid at doctors’ rates even though midwives provided the treatment. This, she said happened despite a federal Medicaid rule saying it "does not permit treatment or referrals to non-physicians for high-risk pregnancy-related services
The lawsuit also alleges that the interest-free line of credit extended to HealthNet by IU exceeded what is allowed under the Affiliation Agreement between IU Health and HealthNet. It says, at times, the line of credit exceeded $10 million and claims that HealthNet did not have to pay back the entire balance.
From the Indiana Attorney General Press release:
HealthNet is designated as a federally qualified health center, and it operates medical clinics within the state of Indiana. Under existing agreements, IU Health OB/GYN practitioners have regularly provided services within the confines of HealthNet clinics, officials said. But officials allege that those practitioners habitually – as part of the improper arrangements – directed patients to IU Health facilities for further treatment (such as labor and delivery services) rather than explain, as they are required to do, that the patients have options.
The Anti-Kickback Statute prohibits an entity from offering or paying money to induce another entity to refer a patient to a provider for products or services for which payment may be made in whole or in part under a federal health care program such as Medicaid. The law is intended to ensure that health care provided to beneficiaries of the public health insurance programs results from sound medical judgment rather than illegal kickbacks.
Indiana will receive $7.78 million from the settlement.
US Attorney Josh Minkler says, “Helping to return millions of dollars in taxpayer funds to federal healthcare programs and the Indiana Medicaid Program is critically important to me and my office,” He also says,“There is no evidence of physical injury or harm to patients as a result of the allegations.”
IU Health provided this statement:
Media Statement:
April 27, 2017 -- Indiana University Health, one of Indiana’s largest non-profit health systems, has resolved the civil case filed by Dr. Judy Robinson through a voluntary settlement agreement reached with Dr. Robinson, the U.S. Department of Justice and the Indiana Attorney General.
IU Health fully cooperated with the government throughout the case and agreed to resolve the allegations without any admission or determination of liability. In fact, the Department of Justice stated in its press release that “there is no evidence of physical injury or harm to patients as a result of the allegations.” There is no merit in Dr. Robinson’s allegations of inappropriate patient care, referrals or billing practices. Instead, the settlement agreement reflects IU Health’s desire to avoid the continued expense and distraction of prolonged litigation.
IU Health is pleased to settle this matter and continues to stand by the integrity and dedication of our outstanding caregivers and the quality of care delivered to all of our patients every day.
IU Health’s long-standing relationship with HealthNet was founded on a shared commitment to ensure access to high quality obstetric and gynecological services for the underserved population in central Indiana.
The ultimate goal was to ensure delivery of service in the most appropriate care setting. The arrangement with HealthNet actually resulted in substantial financial losses, which IU Health considers to be part of its nonprofit mission. IU Health remains committed to supporting HealthNet and its critical role in the effective delivery of services to pregnant women and their families.
-Indiana University Health
The Whistleblower, Dr. Judith Robinson, issued the following statement:
“I’m grateful this case has shined a light on the care that was provided to low income pregnant women and
their babies. I’m hopeful the changes caused by this settlement will help to ensure our community’s most
vulnerable patients get the care they need and deserve.”
See previous stories:
April 17, 2015:
May 1, 2015:
August 11, 2015:
August 12, 2015:
