Government Settles False Claims Act Allegations Against Optim Healthcare

SAVANNAH, GA: Optim Healthcare, based in Savannah, and others have agreed to pay the United States a total of $4 million to settle allegations that they submitted false claims to the Government.

The Government’s investigation was initiated when it received numerous complaints that patients, who lived in the Savannah area, had to undergo major surgical procedures at Optim Healthcare’s rural hospital located in Tattnall County, approximately 90 miles away.  In December 2008, Optim Healthcare purchased then Tattnall Memorial Hospital and later renamed it Optim Medical Center – Tattnall.  The Government alleges that the primary motivation in having these surgeries performed at Optim Medical Center – Tattnall was financial, and not based on patient need or desire.

The settlement announced today resolves allegations that between 2008 and 2012, Optim Healthcare, through its physician-owned hospital in Tattnall County and through its ambulatory surgical center in Savannah, submitted claims for surgical and other medical procedures to Medicare that were: (1) improperly inflated, (2) misidentified in order to receive a higher rate of reimbursement, and (3) in violation of the federal prohibition against physician self-referrals, commonly known as the Stark Law.  The Stark Law is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and is based solely on the best interests of the patient.

United States Attorney Edward J. Tarver said, “Healthcare is not about making as much money as possible.  Programs like Medicare operate on the honesty and decency of its providers, and this office will actively pursue those who misuse the federal healthcare programs or their beneficiaries for financial gain.”

“Today’s settlement demonstrates that the OIG will aggressively investigate all allegations made against trusted healthcare providers who misrepresent services and violate the Physician Self-Referral Statute,” said Derrick L. Jackson, Special Agent in Charge of the United States Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office.  “This kind of behavior adversely affects both patient care and healthcare costs, and will not be tolerated.”

The settlement resolves allegations that were originally part of a federal lawsuit filed under the whistleblower provisions of the False Claims Act which allow private citizens with knowledge of false claims to file suit on behalf of the Government and to share in any recovery.

The case was investigated by Special Agent Mark Creamer, Department of Health and Human Services, Office of Inspector General.  The United States was represented by Assistant United States Attorney Edgar Bueno.  For additional information, please contact First Assistant United States Attorney James D. Durham at (912) 201-2547.