Good Samaritan Hospital in Baltimore has agreed to a $793,548 settlement to put to rest allegations that it made false claims to Medicare and Medicaid for four years, from 2005 to 2008. According to federal officials, the facility noted upon some patients’ admission to the hospital that they were suffering from malnutrition, as a secondary condition. In fact, it is alleged, the patients had not been diagnosed or treated for malnutrition. The hospital allegedly used leading questions to induce physicians to indicate on medical charts that patients were malnourished.
Hospital rates are set in Maryland by the Maryland Health Services Cost Review Commission. The agency decides the rate at which hospital charges will be reimbursed by all insurers, including Medicare, Medicaid and all other federal health benefit programs. In 2005, the agency began to allow for an increased reimbursement when patients are admitted with serious secondary diseases.
By claiming falsely that admitted patients suffer from a secondary condition of malnutrition, a hospital could boost its reimbursement rate for treatment of those patients. This practice, called “upcoding” results in millions, or even billions, of dollars in false Medicare charges to the U.S. government.
The Baltimore Sun reports that Good Samaritan admitted to no wrongdoing and settled the matter rather than engage in a lengthy court battle.
The government’s settlement with Baltimore’s Good Samaritan Hospital was recovered under the federal False Claims Act. Health care fraud allegations of upcoding are often reported by a hospital doctor or employee. The government recognizes that it’s not always easy to speak out about fraud, especially when it involves a health care worker’s employer. As an incentive to reward whistleblowers who do come forward, the False Claims Act contains qui tam provisions that permit individuals who file a claim on the government’s behalf to share a part in any recovery by the government.
Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.