March 8, 2013 — Medicare and Medicaid fraud scams are frequently discovered when an employee of a health care provider brings a whistleblower claim under the qui tam provisions of the federal False Claims Act. The statute allows tipsters to keep a portion of the government’s recovery.
Hospital Admits to Billing Medicare for Unwarranted Hospital Stays
A Towson, Maryland hospital has agreed to pay $4.9 million in settlement to resolve allegations of the hospital’s violation of the False Claims Act, the Justice Department has announced. St. Joseph’s Medical Center has disclosed that between 2007 and 2009, the hospital made a practice of admitting patients to the hospital for stays of one or two days even though the patients’ medical condition did not warrant overnight admission. St. Joseph’s would then bill Medicare and Maryland’s state Medicaid programs for the unjustified hospital stays. By admitting the patients, the hospital received greater reimbursements than it was entitled. St. Joseph’s will pay approximately $4.6 million to Medicare and $152,406 to the State of Maryland.
Medicare False Claims Act Violations Revealed by Insider Employees
In this case, the hospital itself disclosed its own misconduct in filing false claims with Medicare and Maryland’s Medicaid program. Often, though, employee insiders are the ones to report the fraud to the government. Health care workers may even be pressured to take part in a fraudulent scam. That’s when many honest workers find the courage to notify the government.
Before putting the brakes on a scheme to defraud Medicare, informants deserve to know their legal rights. The experienced attorneys at Waters & Kraus provide government collaborators the advice and protection they need to do the right thing. Contact us or call our whistleblower lawyers at 800.226.9880 to learn more about our qui tam practice and how we can help.