February 16, 2013 — EMH Regional Medical Center (EMH) and North Ohio Heart Center (NOHC) in Lorain County, Ohio have consented to pay $4.4 million to resolve a False Claims Act lawsuit filed against the two health care providers by a former laboratory manager with EMH. Allegations of health care fraud are often brought to light when employees file suit under the qui tam provisions of the False Claims Act. Individuals who discover health care fraud are authorized under the statute to file claims on the government’s behalf and take a share of any monies received. The employee whistleblower in this Ohio case will receive $660,859 as part of the settlement.
Whistleblower Alleges Medicare Billed for Unnecessary Angioplasty Procedures
From 2001 to 2006, NOHC, an independent group of physicians, practiced medicine at EMH, a not-for-profit Ohio community hospital system. According to the Department of Justice, EMH and NOHC submitted false claims for payment to Medicare during that time, seeking reimbursement for unnecessary stent placement procedures and angioplasty. The procedures were allegedly performed on patients who did have heart disease, but who did not have sufficiently occluded blood vessels to necessitate stent placement or angioplasty. The misconduct was brought to the government’s attention by a health care insider, Kenny Loughner, who worked at the time as EMH’s manager of the catheterization and electrophysiology laboratory.
EMH will pay the U.S. $3,863,857 and NOHC will pay $541,870.
Medicare False Claims Act Violations Frequently Revealed by Insider Employees
Health care providers that bill Medicare and other government healthcare programs for unnecessary medical procedures drive up the nation’s health care costs. Employee insiders like Mr. Loughner in this case are frequently in the best position to inform the government about Medicare fraud. Health care workers themselves are most likely to know when procedures are not warranted or not reimbursable by Medicare.
Before stepping forward, tipsters need to be informed. Our lawyers at Waters & Kraus provide government collaborators with the answers and assurance they need to help stop health care fraud. Contact us or call our whistleblower lawyers at 800.226.9880 to learn more about our Medicare fraud practice and how we can help.