![]() On June 28, 2018, Ascension Michigan made a submission under the Provider Self-Disclosure Protocol of the U.S. “We will vigorously pursue those who knowingly fail to repay monies they have received based on services that were not medically necessary or not rendered as billed.” Attorney Saima Mohsin for the Eastern District of Michigan. “Health care providers cannot avoid their obligation to repay government funds owed to federal health care programs,” said Acting U.S. The government further alleged that, as a result of these concerns, Ascension Michigan engaged a third-party doctor to conduct a peer review of a sample of the Doctor’s patients, which found that, for the majority of the radical hysterectomies and chemotherapy performed by the Doctor, a less aggressive surgery or medical intervention would have been the standard of care. The government alleged that Ascension Michigan had concerns about the quality of care provided by the Doctor due to patient complaints and his suspected higher than average rates of pulmonary embolisms and surgical infections. 1, 2011, through June 30, 2017, Ascension Michigan knowingly submitted false claims for payment to federal health care programs and improperly retained payment for professional and facility fees related to medically unnecessary radical hysterectomies that the Doctor performed, chemotherapy services that the Doctor administered or ordered that were not medically necessary, and evaluation and management services by the Doctor that were not performed or not rendered as represented. The settlement announced today resolves allegations that, from Feb. “We will continue to ensure that taxpayer funds are used appropriately for the important programs that they support.” Boynton of the Justice Department’s Civil Division. “When hospitals receive payment from federal health care programs for medically unnecessary surgical procedures, they cannot simply retain those payments they have an obligation to return them,” said Acting Assistant Attorney General Brian M. John Macomb Oakland Hospital and Ascension Crittenton Hospital (collectively, Ascension Michigan), all located in Michigan, have agreed to pay $2.8 million to resolve claims that they violated the False Claims Act by submitting or causing the submission of false claims for payment to federal health care programs related to alleged medically unnecessary procedures performed by a gynecologic oncologist (“the Doctor”). We must respond whether we agree with your complaint/grievance or not.Ascension Michigan and related hospitals, Providence Park Hospital, St. If we don’t agree with part or all of your complaint/grievance or don’t take responsibility for the problem you are filing, we will let you know and include reasons for this answer. ![]() If you have a “fast” complaint, it means we will give you an answer within 24 hours. If your health condition requires us to answer quickly, we will do so.Ĭomplaints made because we denied your request for a “fast coverage decision” or a “fast appeal” will automatically be considered a “fast” complaint. However, if we take this extension, we will notify you or your representative. If we need more information and the delay is in your best interest or if you ask for more time, we can take up to 14 more calendar days (44 calendar days total) to answer your complaint/grievance. Most complaints/grievances are answered no later than 30 calendar days from the date you file your complaint. ![]() ![]() If you call us with a complaint/grievance, we might be able to give you an answer on that same phone call. We will look into your complaint/grievance and, if possible, give you an answer right away. What do we do when you file a complaint/grievance? Prior Authorization, Step Therapy, & Quantity Limitations.Coverage Determinations and Redeterminations.
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