Christus Spohn Health Systems, which is based in Kingsville, Texas, has settled a lawsuit with the federal government over alleged Medicare fraud for over $5 million. The lawsuit claimed that six Spohn hospitals regularly billed Medicare for more expensive inpatient procedures, but in reality, they only performed less expensive outpatient procedures.
The lawsuit, which was filed in 2008 by the former case management director for one of the hospitals, also alleged that the whistleblower raised concerns about the unlawful Medicare billing practice to hospital administrators. She resigned from her position after doctors and hospital officials disregarded her complaints. She now lives outside of Texas, according to KXTV. The whistleblower is expected to receive about 20 percent of the settlement, or approximately $1 million.
The hospital chain denies wrongdoing and claims that it discovered the Medicare billing discrepancy through an internal audit, not from the whistleblower.
The False Claims Act provides a means for whistleblowers like the former hospital employee in this case to file suit on behalf of the U.S. government when they believe that wrongdoers have submitted false claims to defraud the government of taxpayer dollars. Under the law, whistleblowers are entitled to receive a share of any resulting judgment or settlement.
Medicare and Medicaid fraud is a major issue and has been the focus of government enforcement initiatives in recent years. In 2009, the U.S. Attorney General and the Department of Health and Human Services announced the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to fight Medicaid and Medicare fraud.
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.