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LIGHTNING TOP 10: No. 2 (2)

Whistleblowers Gloria Pryor, left, Mike Payne and Melissa Church exposed illegal billing and referral practices that forced Park Ridge parent Adventist Health Systems to pay a $118 million fine.

By Bill Moss, Published: December 23, 2015

The Top 10: No. 2

The corporate owner of Park Ridge Health agreed to pay a $118.7 million in fines to settle a whistleblower lawsuit that alleged a pattern of fraud, physician kickbacks, overtesting and overbilling at the Fletcher hospital and other Adventist Health System properties in Florida, Tennessee, Georgia, Texas and Illinois. The whistleblowers were three Park Ridge — Michael Payne, a risk manager who had worked there for nine years; Melissa Church, executive director of physician services and an employee for 15 years; and Gloria Pryor, a compliance officer who had worked at Park Ridge for 19 years. The complaint, filed under the federal False Claims Act, said that Adventist had in the early 1990s “initiated an aggressive strategy” to soak the federal government through inflated Medicare, Medicaid and veterans insurance claims. The lawsuit, which also included whistleblower allegations by a corporate vice president who joined Adventist in 2012, said that Park Ridge and other Adventist units had instituted “referral-driven compensation” that paid “hefty annual salaries” for part-time or nonproductive work, “excessive bonuses” based on hospital revenue and sharing of excess revenue “from known overbilling by employed and contracted physicians.” The arrangements, the lawsuit said, violated the federal Stark Statute, which prohibits hospitals from submitting Medicaid or Medicare claims who have an improper financial relationship with the hospital, and federal anti-kickback and false claims laws. Park Ridge said “Adventist-owned hospitals, such as Park Ridge, allegedly paid doctors bonuses based on the number of tests and procedures they ordered,” U.S. Attorney Jill Westmoreland Rose. “This type of financial incentive is not only prohibited by law, but can undermine patients’ medical care.” Park Ridge said that did not happen in Fletcher. “There were no negative impacts on the quality, safety or individual cost of patient care at AHS hospitals or clinics as a result of these issues,” Park Ridge CEO Jimm Bunch said in a memo to hospital employees. “And as stated in the Department of Justice press release on the issue, ‘the claims settled by this agreement are allegations only, and there has been no determination of liability.’”