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We are attorneys that investigate False Claims Act cases nationwide, including in the state of New Jersey for Medicare fraud, tax fraud, contractor fraud and more against a range of employers including healthcare providers, medical device companies, defense contractors, and pharmaceutical companies. We stand ready to provide a free case evaluation to you; please call us today.
Fifteen Hospital Settlements
As False Claims Act lawyers, we recently saw on the Internet a listing of fifteen False Claims Acts cases from the 2011 calendar year. They are:
1. In January, seven hospitals agreed to pay the United States more than $6.3 million to settle allegations that they submitted false claims to Medicare related to kyphoplasty procedures, a minimally invasive procedure used to treat certain spinal fractures in an inpatient setting, to increase Medicare billings, instead of using less-costly outpatient facilities that are just as safe in many cases. The procedures were allegedly performed from 2000-2008. Lakeland (Fla.) Regional Medical Center agreed to pay the most at $1.66 million. The other six hospitals that have agreed to settle the allegations include the Health Care Authority of Morgan County in Decatur, Ala. ($537,892); St. Dominic-Jackson (Miss.) Memorial Hospital ($555,949); Seton Medical Center in Austin, Texas ($1,232,955); Greenville (S.C.) Memorial Hospital ($1,026,764); Presbyterian Orthopaedic Hospital in Charlotte, N.C. ($637,872); and the Health Care Authority of Lauderdale County and the City of Florence, Ala. ($676,038).
2. Detroit Medical Center announced in January it would pay $30 million to the federal government to settle findings from an internal investigation that uncovered potentially improper relationships between the health system and more than 250 physicians. DMC voluntarily disclosed the findings from its investigation, which included leases that were not at fair market value, free advertising and tickets to events and seminars from 2004-2010. The investigation was conducted before DMC’s sale to Vanguard Health Systems last year.
3. Savannah, Ga.-based St. Joseph’s/Candler Health System agreed in February to pay the state of Georgia $2.717 million in a civil settlement over Medicaid billing for inpatient and outpatient services at its two Savannah-area hospitals. The settlement follows an 11-month investigation that found SJCHS filed claims that were short of the full amount of Medicare prior payments, allowing the system to receive excessive reimbursement. SJCHS also agreed to pay an additional $2,500 to defray the costs of the investigation. The system implemented corrective actions to ensure that similar billing problems do not reoccur.
4. Catholic Healthcare West agreed in February to pay $9.1 million to settle allegations that seven CHW hospitals submitted false Medicare claims. The settlement resolves allegations that three hospitals that received overpayments did not return the funds when Medicare processing errors were discovered; three CHW hospitals submitted inflated costs for their home health agencies and were overpaid; and one hospital was overpaid for treating a high percentage of patients with end-stage kidney disease for several years, including two years when the hospital was not eligible. CHW acknowledged the errors and “is pleased to have resolved this matter.”
5. Rex Hospital in Raleigh, N.C., agreed in April to pay the federal government $1.9 million to settle Medicare fraud charges resulting from a whistleblower lawsuit. The whistleblower alleged the hospital unnecessarily kept Medicare patients overnight following kyphoplasty procedures to boost Medicare revenues when the procedure can be performed on an outpatient basis.
6. In April, Louisville, Ky.-based Norton Healthcare paid the federal government $782,842 to settle claims that it overbilled Medicare for certain services. Norton faced allegations that it overbilled Medicare for wound care, infusion and cancer radiation services by adding a separate “evaluation and management” charge that should have been included in the basic rate. The settlement is twice the amount Norton allegedly overbilled.
7. Dartmouth-Hitchcock Medical Center in Lebanon, N.H., agreed in April to pay $2.2 million to settle allegations that it improperly billed various federal health programs. Federal prosecutors say the case began in 2007 when a physician accused the medical center of improperly billing federal programs for services performed by resident physicians without sufficient supervision by staff physicians. The billings in question spanned from 2001 to 2007. In paying its settlement, Dartmouth-Hitchcock denied any wrongdoing.
8. A California Department of Public Health investigation in May found that Prime Healthcare, a California hospital chain under investigation for allegedly overbilling Medicare, inaccurately diagnosed 22 patients with the blood infection septicemia. HHS is investigating the healthcare system to determine whether it overbilled Medicare for treating septicemia in elderly patients. The probe began in Feb. 2011 after a study of medical records by Service Employees International Union showed that Prime hospitals reported septicemia rates among Medicare beneficiaries at more than three times the national average. Prime Healthcare officials have disputed the public health department’s findings.
9. A former hospital employee filed a lawsuit in May accusing St. Luke’s Hospital in Jacksonville, Fla., of falsely billing Medicare and Medicaid during an 11-month span. The suit, filed by BethAnne Algie, claimed the hospital falsely billed the government from April 2008-March 2009. The suit claimed the hospital was ineligible for Medicaid and Medicare payments because its accreditation allegedly transferred when its former operator, Mayo Clinic, opened a new facility and St. Vincent HealthCare took over St. Luke’s. St. Luke’s allegedly continued claiming Mayo’s accreditation as its own when it was under St. Vincent HealthCare’s ownership.
10. In May, federal investigation began examining physician contracts at Fort Lauderdale, Fla.-based North Broward Hospital District. Agents from the Office of the Inspector General of the Department of Health and Human Services issued the district, also known as Broward Health, a subpoena May 17 to review contracts given to more than 27 physicians for violations of Stark and anti-kickback laws. Agents said they issued the subpoena in connection with an investigation over possible false claims to Medicare and Medicaid relating to physician reimbursements.
11. Community Health Systems, based in Franklin, Tenn., received a subpoena in May from the Security and Exchange Commission regarding its admission practices. CHS said the subpoena requested documents related to various inquiries into the company’s billing practices. The practices allegedly resulted in one-day admissions that should have been billed as observation status visits. The hospital operator is being investigated by the Department of Justice and HHS following a lawsuit filed just weeks before by Tenet Healthcare alleging improper billing resulting from the admission practices. CHS stockholders also filed a suit against CHS for stock losses resulting from the alleged improper billings and resulting investigations.
12. A whistleblower’s complaint against Franklin, Tenn.-based IASIS Healthcare, which claimed the 19-hospital system paid kickbacks in exchange for referrals, was dismissed by a federal judge in Arizona in June. Jerre Frazier, former vice president of ethics and compliance for IASIS, filed the complaint in March 2005, claiming the system performed unnecessary medical procedures and illegally paid physicians for patient referrals to pad profits. In Jan. 2011, IASIS filed a motion to dismiss Mr. Frazier’s complaint and also filed a renewed motion for sanctions concerning Mr. Frazier’s “misappropriation and misuse of privileged documents.” The federal judge ruled in favor of IASIS’s motion.
13. HealthSouth, a Birmingham, Ala.-based operator of rehabilitation hospitals, was subpoenaed in June by HHS for possible submission of improper claims to Medicare and Medicaid. HHS is investigating data related to patient admissions, length of stay and discharge matters at HealthSouth Hospital of Houston. Last year, two former HealthSouth Hospital employees accused the operator of wrongful termination after refusing to commit Medicare fraud. HealthSouth does not know if the federal subpoena is connected to the former employees’ allegations. The company refused to partake in settlement talks with the former employees.
14. UT Southwestern Medical Center in Dallas agreed in September to pay $1.4 million to settle allegations the hospital submitted false claims to Medicaid and Medicare regarding the supervision of resident physicians between 2004 and 2007. UT Southwestern did not admit any wrongdoing but settled the case in order to “to avoid ongoing litigation expenses and prevent further distraction from our mission.”
15. In June, the United States partially intervened in a lawsuit against Daytona Beach, Fla.-based Halifax Health Medical Center, in which the hospital is accused of violating the Stark Law, which prohibits a hospital from billing Medicare for services referred by physicians that have an improper financial relationship with the hospital. The lawsuit, filed by a whistleblower in 2009, claims Halifax’s contracts with three neurosurgeons and six medical oncologists were improper, in part, because they either paid these physicians more than fair market value, were not commercially reasonable or took into consideration the volume or value of the physicians’ referrals. The system has strongly denied the allegations.
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If you would like more information on False Claims Act cases, please continue reading.
THE SCOPE OF FRAUD
Amazingly, some estimates have suggested that approximately 10% of the entire annual United States budget is lost to companies or individuals who are defrauding the government. The United States Federal budget for 2010 was $3.456 billion, meaning around $345.6 million was wrongfully wasted on fraud.
The entities defrauding the government do so in a variety of ways: Medicare or Medicaid fraud whereby they bill the government for services which they never provided or overbill for services that were provided; SEC Trading; Tax Fraud; TARP Fraud; Military/Defense contract fraud; Pharmaceutical Manufacturing;contract fraud involving any number of large government spending programs; or other types public benefit fraud.
HELPING THE PUBLIC.
As a whistleblower attorney, we are interested in speaking with persons willing to make known the truth about company practices and are willing to file a qui tam or whistleblower action. One area in particular we are interested in discussing are lawsuits involving medical device companies where the company is alleged to have overcharged, engaged in kickback programs, and the like. We will nevertheless investigate claims in a variety of areas.
Workers and persons all across the country witness actions at their work that may be unlawful or even corrupt. Unfortunately, some employees and workers feel that they will be fired, terminated, harrassed or punished if they report an unlawful or corrupt action. These reporters, however, are protected by the law as a Whistleblower and can receive compensation because of the False Claims Act or the Medicaid False Claims Act. If you have reported actions that may be fraudulent, then you should talk to a Whistleblower or qui tam lawyer about your facts.
Whistleblowers help the government to get back billions of dollars each year with the help of the False Claims Act. In fact, fraudulent Medicaid claims are also caught by whistleblowers having the Medicaid False Claims Act on their side. If you report a false claim or fraudulent action to the government, then the government will give you, the whistleblower, a part of the money that gets recovered. This is because of qui tam requirements. Qui Tam means that a person files a lawsuit for the king and also for him or herself. The phrase is qui tam pro domino rege quam pro se ipso in hac parte sequitur, or, “he who sues for the king as well for himself.”
These requirements and lawsuits were made popular during the Civil War when many people were getting away with fraudulent actions against the government. In 1986, the False Claims Act was amended to raise the total compensation given to people who reported fraudulent actions, or whistleblowers. If a whistleblower works with a lawyer then it may be possible for them to get three times the amount the government would get in damages and also get additional compensation for general fines.
TYPES OF CASES
The most common situations that could form the basis of a Qui Tam action include:
- -Submitting a false or fraudulent record, bill or statement to the government in order to fraudulently obtain money such as reporting a medical service that was never performed for Medicare or Medicad;
- -Conspiring with a third party to submit or present have a false or fraudulent claim to the government;
- -Withholding property of the government with the intent to defraud or conceal the property from the government;
- -Fraudulently buying property of the government from someone not authorized to sell that property; and
- -Making a false statement to fraudulently avoid paying money to the government or to avoid delivering property to the government.
We will meet with you and thoroughly investigate your case. As we mentioned, we will travel to see you, as we want to meet with you in person and review all documents you may have to support your case. We will then investigate on our own and prepare a complaint for filing in federal court. The case will be filed under seal, and served on the U.S. Attorney’s Office along with a Declaration of Evidence that is not filed but also served on the Government.
Once the case is filed, a United States Attorney investigates the lawsuit and underlying allegations of fraud for an initial period of 60 days. If after investigating the claim the U.S. Attorney believes the allegations of fraud are meritorious, the United States Government takes over the case and either enters into a settlement or continues the lawsuit against the wrongdoer. The Relator would then be entitled to a portion of the recovery despite the fact that the government has taken over the case.
The amount that the Relator would be entitled to receive would be approximately 15 percent to 25 percent of the decision. It is estimated that the government intervenes and takes over a case approximately 30 percent of the time.
