Pomona Valley Hospital ER physicians will spend 1.2 million to settle suit.

September 20, 2000 — Inland Valley Daily Bulletin

by Elizabeth Zwerling – Staff Writer

POMONA — The emergency physicians group that staffs the Pomona Valley Hospital Medical Center has agreed to pay the federal government $1.2 million to settle allegations it overcharged Medicare and other federal health insurance providers from 1995 to 1998.

The settlement, announced Tuesday, resolves a 1998 lawsuit filed by the hospital’s former medical records director Trevor Baylor against California Emergency Physicians, one of the state’s largest emergency physicians group.

The physicians group agreed with the U.S. Attorney’s Office on the settlement amount, but admitted no wrongdoing.

We chose this (settlement) as a prudent business decision, said Curry, whose company provides services at 46 hospitals and 15 urgent care centers in California. The lawsuit and settlement involved only the Pomona hospital.

Curry called the suit, an issue of documentation of medical records. He said his company billed the goverment only for patient services that were rendered.

Thom Mrozek, spokesman for the U.S. Attorney’s Office, said, “It is our assertion CEP did overbill the government by about $600,000.”

Baylor Ahad some evidence that CEP was overbilling federal healthcare programs, for emergency room services, Mrozek said.

The settlement also included the group’s entering into a corporate integrity agreement with the Office of the Inspector General of Department of Health and Human Services. The agreement requires the company to undergo annual audits by Medicare.

Baylor will receive up to 25 percent of the settlement money, Mrozek said.

Baylor’s lawyer, Paul Scott, could not comment on the details of the settlement, citing a confidentiality agreement but said his client was satisfied.

AMr. Baylor firmly believed in the legitimacy of the whistle-blower action when he filed it and he remains convinced today that the case was valid,, Scott said.

The lawsuit was filed under a provision of the federal False Claims Act, permitting citizens to sue an organization on behalf of the federal goverment.

The contents of such whistle blower suits are initially only known by the courts and the U.S. Attorney’s Office, Mrozek said. The U.S. Attorney’s Office then reviews the suit’s allegations and decides if it will prosecute.

Elizabeth Zwerling can be reached by e-mail at e_zwerling@dailybulliten.com or by phone at (909) 483-9381.