St. Peter’s settles with Montana’s U.S. Attorney for false billing violations; Dr. Weiner sued

U.S. Attorney for Montana Jesse Laslovich unveils a $10.8 million settlement agreement with St. Peter's Health in Helena over False Claims Act violations on Aug. 27, 2024. (Photo by Blair Miller, Daily Montanan)

Montana’s U.S. Attorney and St. Peter’s Health in Helena announced Tuesday a $10.8 million settlement agreement over the hospital’s self-reported False Claims Act violations in which it falsely billed several federal medical care programs on behalf of physician and oncologist Tom Weiner, who also faces a federal civil lawsuit alleging he over-billed the government and overprescribed medications.

St. Peter’s Health has 30 days to pay the full amount of the settlement back to multiple federal agencies, including the Department of Health and Human Services, the Defense Health Agency, the Department of Veterans Affairs, Office of Personnel Management, and the Office of Inspector General of the Railroad Retirement Board.

Weiner, the chief medical oncologist at St. Peter’s Cancer Treatment Center who worked there from 1996 until he was suspended and fired in 2020 , was the only medical oncologist physician at the cancer treatment center for the last four years of his career there. According to the civil lawsuit against him, he would typically see 50 to 70 patients each day.

The settlement agreement was made between the hospital and the government comes after St. Peter’s self-reported overpayment concerns for services ordered and performed by Weiner between 2015 and the end of 2020, constituting violations of the False Claims Act.

According to U.S. Attorney for Montana Jesse Laslovich and the settlement agreement, the hospital relied on Weiner’s own documentation regarding billable claims that were actually false.

He would administer chemotherapy, for instance, to a patient and then submit claims for other services performed on the same day. Those, at times, were never performed or were coded at a higher level of service.

Based on the doctor’s claims, the hospital paid Weiner more, boosting his salary far above its base and making Weiner one of the top-earning employees at the hospital, according to the settlement agreement.

“It’s a significant settlement, and it’s a large amount of money. And that’s not lost on any of us,” Laslovich said at a news conference in Helena Tuesday morning. “But it’s reflective of the extent of the conduct we have alleged occurred here.”

Laslovich credited St. Peter’s for self-disclosing its misconduct tied to Weiner, undertaking an internal investigation whose results were provided to the government, disclosing more documentation than was needed, making officers and employees available for interviews, helping determine the full scope of government losses, and revamping its compliance program. Those efforts mitigated the full amount that St. Peter’s will have to pay under the settlement agreement, Laslovich said.

“Because they self-disclosed, because they cooperated throughout the course of our investigation, we believed it was appropriate to only impose single damages, and I appreciate St. Peter’s help in agreeing to that,” he said.

Laslovich said it took four years to reach this point because of the complexity of the case and a lack of resources at the U.S. Attorney’s Office. And he acknowledged the rift between St. Peter’s and Weiner “has divided this community.” For several years, signs saying “I stand with Dr. Tom Weiner” could be seen across Helena as the dispute over his firing moved through the courts.

Laslovich said the investigation did not uncover anyone else involved in Weiner’s scheme, and said the bulk of the settlement money would be going back to the Department of Health and Human Services on behalf of Medicare and Medicaid, which paid out most of the falsely billed funds.

St. Peter’s Health officials say stronger compliance now in place

St. Peter’s Health CEO Wade Johnson said at a news conference later in the morning that the hospital believes the billing issues were isolated to Weiner and that the hospital would pay out the settlement from its reserves and not its hospital operations or planning funds. The total figure represents about 7% of that account, he said, adding that the nonprofit hospital had been planning for such a payment since self-reporting the issues in December 2020.

He said St. Peter’s has since “tightened up” its processes, now conducts pre-audits of its billings processes, and has established a committee to audit physician compensation.

“St. Peter’s is ultimately responsible for maintaining compliance with federal law, and our team has worked hard to ensure we have a much stronger compliance program in place today,” he said.

He acknowledged that the investigation and announcement of a settlement has been tough on employees, but said he believes they take pride that St. Peter’s was “doing the right thing” by self-reporting the billing issues.

“This situation has been disheartening. Obviously, our employees are sensitive to the fact we’re having to pay a settlement,” he said. “They take a lot of pride in the work that they do and the care that they give, and so anything that might appear to detract from that is disheartening for them.”

Laslovich said he and his family have long received care at St. Peter’s Health and he doesn’t want the community to think what is alleged to have happened with Weiner affects the entire hospital. Under the settlement, there is no determination of liability for St. Peter’s.

“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,” he said.

Dr. Weiner additional sued by government

Separately, the U.S. Attorney’s Office on Monday filed a civil complaint against Weiner in the U.S. District Court of Montana alleging two violations of the False Claims Act for billings for services that were not medically necessary and making false claims; unlawfully prescribing controlled substances to the tune of more than 300 of them; and unjustly enriching himself through the false and double-billed claims to the various federal health care agencies.

The lawsuit alleges that part of Weiner’s false claims and over-billing scheme involved scheduling dozens of patients per day for treatment in roughly 15-minute blocks when most oncologists see about 15 patients each day. The suit says oncologists must handle complex treatment plans and be up to date on the ever-advancing medicine for cancer patients, and that Weiner allegedly was not meeting standard medical practice guidelines.

At times, according to the lawsuit, Weiner would bill for codes for work he did not document, and other billing did not justify what he documented.

The suit says he knew his submitted claims were false starting in early February 2018, when an outside consultant’s audit found about 90% of Weiner’s code billing was not backed up by medical records.

When hospital staff spoke to him about it in person and over email in the subsequent months, he complained about the billing system and that he had lost at least $100,000 because some of his claims had not been substantiated and paid out. He threatened a lawsuit, according to the filing.

St. Peter’s Health worked to find ways to help meet his demands, according to the suit, but he would continue his alleged false billing practice through 2020.

“Weiner never decreased his rate of billing E&M claims in 2018, 2019, or 2020, even after he was instructed multiple times about the need for a significant, separately identifiable reason to bill an E&M code the same day as other treatment,” the suit says. “Weiner continued to fill out his superbills and bill those false claims until his suspension and termination at the end of 2020.”

The suit also says Weiner scheduled multiple patients for unnecessary visits between chemotherapy cycles to generate more bills, used a scanning method that went beyond what was needed for the patient and possibly led to a patient’s regression, prescribed a post-cancer-treatment drug years beyond what was needed, and used non-standard chemotherapy regimens on patients.

It also alleges that he far overprescribed opiates to certain patients, even some who had showed addictive behaviors, well beyond guidelines for opiate prescription.

“Weiner issued at least 316 prescriptions to 11 separate patients for opioids and other controlled substances that were not for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional capacity,” the lawsuit says.

The government is asking for damages on the False Claim Act violations, maximum penalties under it and the Controlled Substances Act, a prohibition on Weiner issuing controlled substance prescriptions for at least five years, for money back based on the amount Weiner enriched himself, and for attorneys’ fees and costs.

Neither Laslovich nor Johnson said they could comment on the new case because it involves pending litigation.

Last August, a Lewis and Clark County District Court judge sided with St. Peter’s in Weiner’s wrongful termination lawsuit against the hospital. Weiner appealed that judgment to the Montana Supreme Court in February, and the appeal is now fully briefed and will be considered by a Supreme Court panel.

According to the Montana Board of Medical Examiners database , Weiner’s license is still active and in good standing. He’s been a licensed physician in the state since 1996, and his license expires in March 2025. The database also shows no disciplinary actions taken against his license.