St. Peter’s Health Reaches $10.8 Million False Claims Act Settlement for Actions Taken by Oncologist

St. Peter’s Health in Helena, Montana recently reached a $10.8 million False Claims Act settlement over self-reported False Claims Act violations in which the company falsely billed several federal medical care programs on behalf of Tom Weiner, an oncologist. Weiner faces a separate federal civil lawsuit over allegations that he over-billed the government and overprescribed medications to patients.

The government alleged that between January 1, 2015, and December 31, 2020, St. Peter’s Health, when relying on Dr. Weiner’s documentation and certification, submitted claims that were false. The United States contends that St. Peter’s Health knew or should have known that Dr. Weiner was upcoding claims or submitting non-payable claims that did not meet the requirements of a significant, separately identifiable service, and therefore, St. Peter’s Health violated the False Claims Act by submitting those claims to Federal Health Care Programs.

Weiner served as the chief medical oncologist at St. Peter’s Cancer Treatment Center, working at the Center from 1996 until his suspension and ultimate firing in 2020. Weiner was the sole medical oncologist physician at the Center during the last four years of his career. According to the civil lawsuit, he would see between 50 and 70 patients most days.

St. Peter’s entered into the settlement agreement after self-reporting overpayment concerns about Weiner’s service billings. For example, he may administer chemotherapy to a patient and submit claims for other services that were performed on the same day that were either never performed or were coded at a higher level of service than what was provided. Based on Weiner’s billing levels, the hospital paid Weiner a greater amount, making him one of the top-paid employees at the hospital.

United States Attorney for Montana, Jesse Laslovich, gave credit to St. Peter’s for self-disclosing the misconduct and initiating an internal investigation (and providing those results to the government). St. Peter’s also provided more documentation than what was requested and made officers and other employees available for interviews. Since uncovering these issues, St. Peter’s has enhanced its compliance program. These actions mitigated the amount that St. Peter’s will pay under the settlement agreement.

Laslovich noted that it took four years to reach the settlement because of the complexity of the case and lack of resources within his office. He noted that the investigation by his office did not result in anyone else being connected to the scheme and that the majority of the settlement money would be going back to the Department of Health and Human Services (HHS) on behalf of Medicare and Medicaid – which paid out the bulk of the falsely billed income.

St. Peter’s Health CEO Wade Johnson believes that the issue was isolated to Weiner and that the settlement amount would come out of the hospital’s reserves, not its operations or planning funds. He further commented that to avoid such a problem in the future, St. Peter’s now performs pre-audits of its billing processes and has a committee that audits physician compensation.

The total settlement amount – $10,844,201 – includes $9,988,970.15 in restitution and is to be paid by St. Peter’s Health no later than 30 days after the settlement date.

“Today’s settlement, in my view, is not an indictment on the quality of care being provided by St. Peter’s Health, as well as their doctors and providers, nor is it a reflection of the current leadership of St. Peter’s health, as this leadership team voluntarily self-disclosed the misconduct,” Laslovich said.