Healthcare Fraud Whistleblower Cases Settle for $98 Million
Community Health Systems is the nation’s largest operator of acute care hospitals. Based in Franklin, Tennessee, the company operates 206 hospitals in 29 states. Earlier this month, the company settled 7 whistleblower suits all accusing the hospital chain of massive healthcare fraud.
Nine whistleblowers had filed seven lawsuits across the United States. All were filed under the federal False Claims Act, a whistleblower statute that dates back to the Civil War. Under that law, whistleblowers can earn an award up to 30% of whatever the government collects. That means 9 lucky people could soon be walking home with $30 million. (The average award is more commonly 20%.)
One of the suits that was just unsealed claims that Community Health Systems billed Medicare for inpatient services that should have been billed as outpatient or “observation” services. Outpatient services are usually less costly. The government also claimed that Community engaged in “a deliberate, corporate-driven scheme” to increase inpatient admissions of patients receiving government funded healthcare such as Medicare and Medicaid. In many cases patients received medically unnecessary care.
Dr. Thomas Mason, an emergency room doctor at a North Carolin Community Health hospital, was one of the whistleblowers. To qualify for an award, whistleblowers must have original source information. That usually means they are employees or vendors with close access to the company and knowledge about the fraud. As a doctor, he had first hand knowledge of Community’s admission policies.
In a prepared statement, Charlotte, North Carolina’s U.S. Attorney, Anne Tompkins, said, “[Dr. Mason] and his lawyers have been available to assist the United States multiple times in this case. Information from citizens like Dr. Mason and the work of their legal representation is essential to detecting and stopping fraud against government health care programs and recovering public funds.”
Overall, Community Health will pay over $98 to settle the charges. They also agreed to a 5 year Corporate Integrity Agreement which will require independent monitors to review Community’s claims for inpatient care. The company was allowed to settle without admitting any guilt or wrongdoing.
Many if not all of the whistleblowers were former Community Health physicians. Some claim that their contracts were not renewed after they reduced to accept bribes offered to get the doctors to admit more patients. If that’s true, they may be entitled to additional damages as well. That’s because federal law has strong anti-whistleblower retaliation provisions.
Medicare fraud is not a victimless crime.While millions of Americans struggle to receive adequate healthcare, some providers are bilking the system and getting millions in overpayments. Worse, in Community health’s case the government claims that some patients received medically unnecessary treatment putting them at risk of further harm and complications.
How To Obtain a Whistleblower Award
To obtain a whistleblower award in a federal false claims case, one must have original source information about a crime involving fraud on the government or a government funded program. Since Medicaid and Medicare are funded with tax dollars, most healthcare fraud qualifies under the law.
To receive an award, the whistleblower must first file a lawsuit. The suit is filed under seal and remains secret while the government investigates. Once the investigation is complete, the government has the opportunity to to take over the case.
Whistleblower photo courtesy of Dave Winer – scriptingnews
—
Mahany & Ertl has represented whistleblowers in some of the largest cases in the United States. We are proud of what we do and believe that whistleblowers are America’s true heroes. Often the difference between a large cash award and nothing is the quality and zeal of the lawyer. Having a great whistleblower lawyer can make all the difference in he world. Want more information? Contact attorney Brian Mahany at or by telephone at (414) 704-6731. All inquiries are kept in strict confidence.