Gloria Pryor, Mike Payne, and Melissa Church are grinning because they turned in Park Ridge Health for fraudulent practices in 2012, and now Park Ridge has to pay them a cut of a $118.7 million fee owed the US Justice Department and four states. Sherry Dorsey will probably get something, too, for a second complaint lodged in 2013. I am grinning with them.
Park Ridge was faulted for “upcoding and overbilling.” That those are words indicates they are not unusual practices. The scheme involved giving doctors kickbacks for driving business to the hospital. Techniques included giving doctors, who were gobbled up in mass hospital acquisitions, bonuses for referring patients to the hospital for procedures that could have been handled in the doctors’ offices. The hospital then charged so much, both referring physicians and the hospital came out ahead – monetarily. Patients were further referred for services they did not need; some getting treatments four times more often than necessary.
Kickbacks took sundry forms, including allowing a physician to command a six-digit salary while working only three days a month, forgiving $190,000 in debt for one guy, and making lease payments for a Mustang and BMW. The kickbacks evolved as practices were questioned. They are referred to as “contribution margins.”
Pryor was accused of being too “compliance conservative” when she indicated issues abounded. CFO Karsten Randolph saw no point in reporting the issue to the Centers for Medicaid and Medicare, who wish to protect patients from waste, fraud, and abuse; because, according to the Hendersonville Lightning:
the amount of money due to the government would be ‘insane.’
