ENFORCEMENT

Whistleblower Sues Montana Health System Officials for Elaborate Kickback Scheme

Case: The CFO of a Montana hospital physician network filed a qui tam lawsuit against his employer for paying physicians above-market compensation in exchange for referrals to network labs, hospitals, clinics and specialists.

Significance: The network, the biggest in Montana, denies the charges and contends that the Work Relative Value Units (WRVU) system it uses to measure physician productivity is the same method commonly employed by other hospitals across the country. But the CFO contends that the WRVU system is just a smoke screen to conceal payments based on referrals rather than productivity, citing among other examples, a neurosurgeon paid $900K per year even though collections for his services ranged from $207K to $374K, which is roughly the 10th percentile for neurosurgeons in national productivity metrics.

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