"As a key part of the Defendants' Cost Padding Scheme, Defendant Walters, through Defendant Performance Capital Leasing, LLC ("PAR"), which was owned and controlled by Walters, entered written agreements with Hospital Defendants, not in order to provide services necessary to or directly to patient care, but to create higher costs and thus higher Medicare revenues for the Hospital Defendants as an end in itself." 45.
"Under such agreements, the Hospital Defendants engaged Walters and PAR to 'develop and implement strategic plan(s) to restructure (the) hospital's operations to all for maximum cost based reimbursement,' pursuant to which PAR promised to provide 'monthly operating reports demonstrating revenue generation.' " Defendant Walters through defendant PAR was given substantial managerial control in a 2005 contract with North Sunflower Hospital.
The four defendants are accused of using their companies: Piercon, Inc.
(Piercon), dismissed 3.21.18 Performance Accounts Receivables (PAR), Performance Capital Leasing (PCL), Stepping Stones Healthcare, LLC (SSH) 43.
to pad and inflate costs, the amounts of which were falsely represented on the Hospitals Defendants' cost reports to Medicare as directly related to (and as necessary to) patient health care (but the central purpose and effect of which was to enrich Walters and the remaining Defendants other than Hospital Defendants).
All of those activities by the 'Defendants' Cost Padding Scheme.' " 44.
Claims By and on Behalf of the United States for Making False Claims (and for Causing False Claims to be Made) 76. subsection 3729(a)(1), and as amended in 2009 and codified as 31 U.
Critical Access Hospitals named in paragraph 21 of the original filing, Perry County General Hospital, LLC Quitman County Hospital, LLC Hardy Wilson Memorial Hospital Noxubee General Hospital 58.
A recently unsealed whistle blower civil action known as a "Qui Tam" has made allegations of a widespread scheme to defraud Medicare at seven "Critical Access Hospitals" (CAH) across the State of Mississippi, since 2005. Together the two uncovered the alleged fraud in 2012 at Pearl River County Hospital and through investigations, put together a complaint that details evidence of fraud involving seven Mississippi Hospitals.
Monsour alleged violations of the False Claims Act (FCA) and the Anti Kickback Act (AKA) Vaughan is the CEO and Administrator of Pearl River County Hospital and Monsour is a health care executive and management consultant hired by Vaughan.
According to the complaint, By agreeing to link their payments to Walters and PAR directly to the amount of Medicare revenue collected by each CAH, each such Hospital Defendant left no doubt that it was engaging Walters and PAR to increase the revenues as an end in itself, rather than to cause an efficient expenditure of costs actually necessary to patient care (as required by the Medicare laws described above). As a further and related part of the Defendants' cost padding scheme, Walters recruited, and caused Hospital Defendants to enter purported service contracts with, other entities who or which would be paid by the Hospital Defendants to enter purported service contracts with, other entities who or which would be paid by the Hospital Defendants, not on the basis of any reasonable or market value of services rendered for patient care, and not on the basis of any services of any kind that they would render, but instead based on how much those other vendors or contractors succeeded in increasing the reported costs (and thus Medicare revenues) associated with their area of hospital operations.
Critical Access Hospitals (CAHs) are limited to 25 beds, and operate in rural and generally economically deprived and medically undeserved areas of the United States.