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Qui Tam Whistleblowers Expose Medicare Fraud and Obtain Big Payoff

Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for above-the-bar-logo.jpgFourteen hospitals settled allegations this week of violating the False Claims Act by agreeing to pay over $12 million to the U.S. government. All the hospitals, located in New York, Mississippi, North Carolina, Washington, Indiana, Missouri and Florida, had submitted false claims to Medicare. Among the New York hospitals, North Shore Syosset Hospital will pay $192,735 while Plainview Hospital has settled for $2,307,265. If you work in a hospital or a health care facility and know of fraudulent claims being filed against the government, call our Medicare Fraud Attorneys to help you determine if you have an action under the False Claims Act.

This lawsuit was brought by two qui tam whistleblowers, Craig Patrick and Charles Bates, under the False Claims Act. The Act allows individuals with knowledge of fraud being committed against the government to bring an action on behalf of the government and to receive a percentage of the recovery. Patrick was employed as a reimbursement manager at Kyphon and Bates was employed as a regional sales manager for Kyphon. For bringing the lawsuit on behalf of the government, the two individuals will receive a total of about $2.1 million of the recovery.

The lawsuit charged the hospitals with overcharging Medicare between 2000 and 2008 when kyphoplastys were performed. Kyphoplasty is a procedure performed to treat certain spinal fractures caused by osteoporosis. It is minimally invasive and can be done as an out-patient safely and at a much reduced cost. The government alleged that these hospitals performed the procedure on an inpatient basis to increase their Medicare billings.

The allegations in these settlements all case stem from the government’s settlement with Medtronic Spine LLC, the corporate successor to Kyphon, Inc., in 2008. The $75 million settlement resolved allegations that Medtronic committed Medicare fraud by counseling hospital providers to admit patients for inpatient hospital stays to perform kyphoplasty procedures in order to increase their Medicare reimbursement although the procedure could have been done on an outpatient basis in many cases. Thereafter, the government aggressively began going after health care providers who billed for inpatient stays following a kyphoplasty. The government’s initiative has resulted in settlements with over 40 hospitals with a recovery of over $39 million.

If you’re a healthcare provider, make sure you have not over billed Medicare. In light of the government’s crack down on Medicare fraud, it is not unwise to conduct an internal audit of your Medicare billing and reimbursements to ensure that you’re not submitting any false claims. If you have received any over payments, you must pay the money back within 60 days. Failure to do so could result in triple damages and penalties of $5,500 to $11,000 per claim. Our attorneys have helped many healthcare providers examine their billing as well as referral relationships to ensure that they are not violating the False Claims Act.

Tony West, Assistant Attorney General for the Justice Department, stated that “Patients want reassurance that their health care provider is making treatment decisions based on the patient’s best interests, not an interest in maximizing profits. When healthcare providers submit false claims to increase their Medicare reimbursement, it not only takes a toll on the country’s cost of health care, health care is compromised.”

If you know of fraud being committed against the government, call our Whistleblower Attorneys at Villanueva & Sanchala at (800) 893-9645 to discuss if you have a possible cause of action under the False Claims Act.

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