The United States Department of Justice has intervened in a whistleblower complaint filed by an Alabama physician. The complaint alleges that LifePoint Hospitals and the Vaughan Regional Medical Center conspired to staff the hospital’s emergency room with unlicensed foreign medical students. Court filings indicate that the case may be nearing resolution.
The initial complaint was filed in 2014 by a doctor who had inside knowledge of the hospital’s staffing practices. Under the federal False Claims Act, citizen whistleblowers with inside knowledge of fraud can file a lawsuit on behalf of the United States. If the case is successful, the whistleblower is entitled to between 15% and 30% of the proceeds.
According to the complaint, beginning in April 2012, Elite Emergency Services, LLC contracted with Vaughan Regional Medical Center to provide emergency department physician staffing services.
For years there was an apparent shortage of qualified emergency room doctors in the Selma area. To fill the gap, Vaughan began using another staffing company, Integrity Emergency Care, Inc. The hospital and Integrity then began using unlicensed medical residents who had attended medical schools outside the United States.
Not only were these residents unlicensed, the complaint says they were uninsured. That certainly put patients at risk.
Using medical residents from foreign medical schools is legal but only if they are properly supervised.
Vaughan Regional Medical Center was allowed to have residents in their ER but only if they were supervised by licensed physicians and paid through a recognized residency program. Apparently the hospital was doing either.
During the day there would typically be one resident and one licensed physician. At night, however, the unlicensed doctors were alone and unsupervised.
The practical effect of this arrangement was that these students “examined patients, gave medication orders, gave treatment orders and performed invasive procedures on patients without supervision from licensed physicians or otherwise.”
To get around the problem, the residents were paid under the table in cash. Licensed doctors would sign treatment records and claim that they either provided the services or supervised the residents.
The whistleblower complained about the program but he was ignored. Ultimately, he filed a whistleblower complaint. Since then, he believes that the hospital records have been “forged, altered and/or redacted to remove any mention of unlicensed [the unlicensed] residents practicing unsupervised medicine at Vaughan Regional Medical.”
Whistleblower Complaints for Unlicensed Doctors
We have seen several cases where clinics use unlicensed and unqualified therapists and mental health workers. Obviously, that practice is illegal.
We recently a case where a doctor in Arizona couldn’t get licensed yet a clinic kept him on the payroll. At least he was licensed, just not in the proper state. We have even seen unlicensed dentist and optometrist cases.
Common are cases where physician assistants bill as physicians. But again, at least they are licensed. This case is a first for us…doctors that aren’t licensed anywhere nor supervised. Until they complete their residency and get credentialed they are in effect students.
This case may be a first but we often find in these schemes that other hospitals are doing the same thing.
Lest you feel sorry for Vaughan Regional Medical Center’s claims that it couldn’t find doctors, what they are really saying is that doctors were expensive. Assuming the allegations are true, they made a conscious decision to save money and cut corners. They cut corners by using unsupervised and unlicensed doctors and then covering up their tracks by paying them cash under the table and using licensed doctors to sign off on patient charts.
Who suffers? Patients and taxpayers.
The patients suffer because they are being treated by doctors who aren’t ready to see patients on their own. Taxpayers suffer because Medicare and Medicaid are paid with tax dollars. Our tax dollars.
Under the federal False Claims Act, whistleblowers can receive reward if the underlying fraud involves federal funds. And Medicare and Medicaid certain qualify. (Alabama is home to many military families; the military healthcare program Tricare also involves federal monies.)
To qualify for a reward, one generally must be the first to file and have inside information about the fraud scheme. The whistleblower in this case, a doctor who worked at Vaughan Regional Medical Center, certainly qualified.
When a hospital submits bills to Medicare or another qualifying plan, it must certify that it is in compliance with all rules and regulations. The government thought it was paying for licensed doctors or at least supervised residents. It received neither.
Under the law, the government can get back all it paid and receive triple damages. It is easy to see how quickly rewards can add up.
Whistleblower cases are filed under seal meaning they are secret. This one was filed in 2014. While being investigated the case remains secret. Ultimately the government must intervene (take over), let the whistleblower’s own lawyer prosecute or ask the court for the case to be dismissed.
In this case, the matter remained secret for five years. Now the government has decided to intervene meaning they believe the case has merit. The Justice Department suggests the case is close to settlement.
We remind everyone that until settled, the allegations are just that. There has been no finding of wrongdoing and very often, these cases settle with the defendant being allowed to pay a penalty without admitting any wrongdoing.
Do You Have Knowledge of Unlicensed Doctors Working in Hospitals?
Mahany Law is one of the most successful whistleblower law firms in the country. We fight for whistleblowers and taxpayers nationwide.
Unlicensed doctors and other unlicensed healthcare workers are a threat to public health. This case involved residents that were not only unlicensed, allegedly they were also unsupervised. That’s scary stuff!
To learn more about Medicare fraud and whistleblower rewards, visit our healthcare whistleblower information page. Ready to see if you have a case? Contact us online, by email or by phone 202-800-9791. We accept cases nationwide.
*This post details billing fraud involving unlicensed medical professionals. See also our post about false credential Medicare fraud schemes.