A recently unsealed federal lawsuit out of the state of Indiana has accused health provider Ascension of obtaining millions of dollars in funds by submitting thousands of false claims to Medicaid.
Two former state officials filed a “whistleblower” lawsuit that alleged several Indiana hospital systems and managed care entities committed “tens, likely hundreds” of millions of dollars of Medicaid fraud.
The former officials filed the lawsuit in early 2021 when they obtained access to analysis from Indiana’s “fraud and abuse detection system” contractor, IBM Watson Health. The case was sealed until earlier this year.
The lawsuit language reads: "This is a civil action on behalf of the Government and the State to recover treble damages and civil penalties for Medicaid fraud. Specifically, each of the MCE Defendants has knowingly and improperly misused tens, likely hundreds, of millions of dollars of Medicaid funds to pay claims that A) violated basic hospital billing rules such as those disallowing two separate in-patient claims when the patient is readmitted right away for the same condition, B) were clearly not payable because they were for services after patients’ death or were duplicative of already-paid claims, and C) contravened Medicaid billing requirements for chiropractic, dental, and opioid treatments. Each of the Hospital Defendants, in turn, knowingly and improperly obtained tens of millions of dollars from Medicaid by submitting thousands of false claims that either A) violated basic hospital billing rules or B) were clearly not payable. This misconduct by the MCE Defendants and Hospital Defendants, moreover, has contributed to the “nearly $1 billion budget shortfall” for Indiana Medicaid that emerged in December 2023, which has led to significant cuts to services for the elderly and disabled children in Indiana."
Among the accusations made against Ascension: "Other members of Indiana Medicaid’s Program Integrity team and Provider Relations team offered similar alerts and warnings about claims for services after date of death and duplicate claims to the Hospital Defendants during other regularly scheduled meetings and trainings.
2) Defendants IU Health, Ascension, Community, and Parkview Knowingly Submitted Medicaid Claims for Services Supposedly Given After Patients’ Deaths
Additionally, talk of hospitals buying political influence and an official who later worked for Ascension are mentioned in the footnote of a paragraph on public officials apparently trying to halt investigation into Medicaid fraud issues:
"Starting in late 2017, and bowing to political pressure exerted by the health insurers’ and the hospitals’ lobby, a senior executive at Indiana Medicaid improperly directed the Program Integrity team to significantly curtail its efforts to utilize IBM Watson’s analysis and findings to recoup improper Medicaid overpayments by MCE Defendants and to the Hospital Defendants."
00:00All right, as always, you can go to YouTube channel My Medical Nightmare and see 40 plus hours video on everything that happened to me.
00:10All right, Ascension named as two former Indiana state officials have filed a whistleblower lawsuit that alleges that the hospital system committed tens, likely hundreds of millions of dollars of Medicaid fraud.
00:26This is according to an article published by WFYI-FM, Poet Radio out of Indianapolis, Indiana, dated September 17, 2024.
00:40They write, the former officials filed the lawsuit in early 2021 when they obtained access to analysis from Indiana's fraud and abuse detection system contractor, IBM Watson Health.
00:55The case was sealed until earlier this year.
00:59They write the lawsuit alleges four companies in charge of managing Indiana Medicaid knowingly and improperly misused millions in Medicaid funds to pay claims that violate billing requirements.
01:13It also said six hospital systems obtained millions of dollars in funds by submitting thousands of false claims to Medicaid.
01:22In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources.
01:31The program is partially funded and primarily managed by state governments.
01:35All right, so at WFYI's website for this news story, you can read 77 pages of official documents.
01:46Some of the false claims scenarios mentioned here include improper claims for services supposedly rendered after beneficiaries' deaths, improper separate hospital inpatient claims despite readmissions within 72 hours, improper hospital transfer claims, improper inpatient claims without 24-hour hospital stays, improper retention of capitated payments.
02:15After Medicaid beneficiaries' deaths, duplicate claims for the same service.
02:21The introduction reads,
02:51Each patient is readmitted right away for the same condition, B, were clearly not payable because they were for services after patients' deaths or were duplicative of already paid claims, and C, contravened Medicaid billing requirements for chiropractic, dental, and opioid treatments.
03:11Each of the hospital defendants, in turn, knowingly and improperly obtained tens of millions of dollars from Medicaid by submitting thousands of false claims that either A, violated basic hospital billing rules, or B, were clearly not payable.
03:27This misconduct by MCE defendants, moreover, has contributed to the nearly $1 billion budget shortfall for Indiana Medicaid that emerged in December 2023, which has led to significant cuts to services for the elderly and disabled children in Indiana.
03:47Additionally, reports that a senior executive at Indiana Medicaid may have tried to squash investigation attempts into fraud practices.
04:01It is curiously mentioned within the same paragraph that mentions political influence.
04:09An attorney of a health care lobbyist firm was appointed Administrator of Indiana Medicaid in 2017 and then signing on as Ascension's Chief Advocacy and Public Policy Officer.
04:24According to this lawsuit language, starting in late 2017 and bowing to political pressure exerted by the health insurers and the hospital's lobby,
04:35a senior executive at Indiana Medicaid improperly directed the program integrity team to significantly curtail its efforts to utilize IBM Watson's analysis and findings
04:50to recoup improper Medicaid overpayments by MCE defendants and to the hospital defendants.
04:58There's a footnote that reads,
05:01Public disclosures show that the MCE defendants, the hospital defendants, and lobbyists on their behalf have spent hundreds of thousands of dollars on political contributions to recent state elections.
05:14As a result of those political contributions and direct lobbying, an attorney from one of Indiana's largest health care lobbyist firms was appointed as the Administrator of Indiana Medicaid in 2017.
05:31After leaving Indiana Medicaid in June 2023, she became Defendant Ascension's Chief Advocacy and Public Policy Officer.
05:42All right, so yeah, this applies to the state of Indiana.
05:47Many of my videos primarily deal with the situation around Birmingham, Alabama.
05:51I've encountered a corruption that resonates with some of the language of this unsealed federal lawsuit.
05:59In late 2023, I did this video, which mentioned one of Ascension's partner companies, Birmingham Radiological Group,
06:09erroneously billed patients after they have died.
06:13And again, this is in the state of Alabama.
06:17A Banner Business Bureau complaint from 2023 confirms Birmingham Radiological Group erroneously sends bills to patient families for procedures performed after they had died.
06:30The complaint spouse mentions this was for a scan performed in 2022, although the patient in question has been deceased for several years.
06:41Multiple attempts to correct this issue and obligations made by Birmingham Radiological Group to the patient's family have not been successful.
06:51So yeah, it looks like this may be the tip of a very large iceberg.
06:57I myself am aware of several investigations by the United States federal government into the business dealings of Ascension and its partners.
07:08If you want some clues on the type of corruption that's going on, please check out the patient customer reviews and complaints on the Better Business Bureau website, for example.
07:24And then you can see an inside picture of what's going on through the employee reviews on the nd.com website.
07:34You've reached the Ascension System Office General Mailbox.
07:37After the tone, leave a detailed message and someone will respond to your call.
07:45I'm trying to reach CEO Joseph Impechike, and he can contact me at that number.
07:51And I have a message that I would like to give to Ascension.
07:55Between 2018 and 2019, I was an emergency department patient at Ascension St. Vincent's East Hospital in Birmingham, Alabama.
08:04I believe I had broken my neck.
08:07I had an x-ray, two CT scans, and later an MRI looked at by Ascension St. Vincent's doctors.
08:14Each time they had told me I had no injuries in this area, I knew their diagnosis was an error as my condition worsened.
08:22The area became infected and infested with parasites by summer of 2019.
08:28I almost died.
08:29I obtained my medical records from your hospital along with the x-ray, CT, MRI imagery, and discovered the truth of my injury.
08:36I had broken bone in the underside of my skull in the area of the condylar canal and occipital condyle.
08:42How the doctors could admit such a large and serious injury over multiple hospital visits is inexcusable.
08:48I believe some element of organized corruption may exist in this hospital.
08:54I have compiled over 10 hours of video documentation on what happened to me on my YouTube channel.
09:01And the name of the channel is My Medical Nightmare.
09:04I believe I may have been a victim of patient dumping in the course of my seeking treatment, which is a violation of EMTALA, E-M-T-A-L-A.
09:13When I told medical staff associated with Ascension about my discovery, that I had been misdiagnosed repeatedly, I was personally attacked and my psychological state was challenged.
09:26And this is reflected in medical records I obtained later.
09:29I could not obtain proper treatment or diagnosis for this injury because doctors and nurses that I would subsequently have encounters with would only entertain what the erroneous Ascension ER findings were.
09:46My mother, who was a nurse for 20 years, had the misfortune of working in an Ascension hospital.
09:52When I questioned my MRR findings involving St. Vincent's Ambulatory Healthcare Network, LLC, and Dr. Michael Brandt Ruff, MD, radiologist, in March 2019.
10:05My mother, who was a nurse for 20 years and worked in the Ascension hospital, she was terminated from her job there around the same time.
10:12And so this phone call, I challenge the misdiagnosis of Ascension St. Vincent's East Hospital, Birmingham, Alabama, and I challenge the policy of this hospital.
10:24And Mr. P.GK, I think you need to look into this, please.
10:28Please listen to my message, look into what I'm saying, and you're free to contact me.
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