HCA Settles Allegations of Billing for Unnecessary Lab Tests and Double Billing for Fetal Testing for $2,000,000

Contact Person: Jennifer Aldrich (803) 929-3000

COLUMBIA, South Carolina ----  United States Attorney Bill Nettles announced today that the United States Attorney's Office for the District of South Carolina with the State of Florida, settled claims of health care fraud with HCA Holdings, Inc. f/d/b/a HCA, Inc. f/d/b/a HCA – Hospital Corporation of America f/d/b/a Hospital Corporation of America and Parallon Business Solutions, LLC, West Florida Regional Medical Center, Inc. d/b/a West Florida Hospital; HCA Health Services of Florida, Inc. d/b/a Regional Medical Center Bayonet Point; HCA Health Services of Florida, Inc. d/b/a Oak Hill Hospital; and New Port Richey Hospital, Inc. d/b/a Medical Center of Trinity (“HCA”). 

The United States and the State of Florida contended that HCA submitted laboratory claims for direct count low density lipids (LDL) when the tests were not ordered and/or not medically necessary at four hospitals in Florida: West Florida Hospital; Oak Hill Hospital; Regional Medical Center Bayonet Point; and Community Hospital of New Port Richie (Trinity Hospital).  The United States and the State of Florida also contended that HCA submitted claims for fetal biophysical profiles with non-stress tests (CPT code 76818) and additionally submitted another claim for a standalone non-stress test (CPT code 59025) at Community Hospital of New Port Richie (Trinity Hospital) during the period from January 1, 2007 through September 26, 2014. 

The investigation began with the filing of a whistleblower lawsuit called a qui tams lawsuit under the False Claims Act.  The suit was filed by an employee of HCA and was captioned United States, the District of Columbia, the States of Florida, California, Colorado, Georgia, Indiana, Louisiana, Nevada, Oklahoma, Tennessee, Texas and Virginia ex rel. Kelly Oxendine v. HCA Holdings, Inc. f/d/b/a HCA, Inc. f/d/b/a HCA-Hospital Corporation of America f/d/b/a Hospital Corporation of America, and Parallon Business Solutions, LLC.   The False Claims Act allows the government to recover actual damages and penalties of three times the actual damages and up to $11,000 per false claim.  This settlement includes repayment of actual damages and penalties. 

The False Claims Act allows individuals to file lawsuits with allegations that fraud has been committed against the federal government on behalf of the government.  Whistleblowers, referred to as Relators in the False Claims Act, are entitled to share in any recovery received by the government.  In this case, the relator will receive 20% of the funds of the settlement or $400,000 plus she is entitled to her costs and attorney fees.

          Mr. Nettles said “This office has made a substantial commitment to combating fraud. Our commitment has made this district one of the leaders on behalf of the whistleblowers.  We hope that those who commit fraud will recognize that it is our goal to make the consequences more than just the cost of doing business.”

          This case was investigated by agents from U.S. Health and Human Resources Office of the Inspector General and the Defense Criminal Investigative Service.

          If you suspect Medicare or Medicaid fraud please report it by phone at 1-800-447-8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov.

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