There have been numerous qui tam cases brought under the False Claims Act whereby whistleblowers sought to report hospital fraud. These qui tam cases have settled against hospitals, hospital systems and medical centers. The qui tam whistleblowers were often employees of the hospital, including:
- nurses,
- medical staff,
- physician assistants,
- billers,
- doctors, or
- support staff.
If the whistleblower seeking to report hospital fraud knows that state Medicaid money is involved, a qui tam can also be brought under State False Claims Acts,
Report Hospital Fraud: Kickback and Stark Law
One type of hospital fraud involves kickback and Stark violations. A whistleblower seeking to report hospital fraud filed a qui tam case against Health Alliance of Greater Cincinnati. The qui tam complaint contained claims that the hospital paid money to cardiologists in exchange for the doctors referring patients to the hospital. The hospital fraud case settled for $108 million.
Another hospital fraud case settled in 2015 for $69.5 million. The qui tam case alleged that a Florida Hospital paid certain referring physicians improper excessive compensation. It was further alleged that the compensation exceeded fair market value. Paying compensation over fair market value violates the Stark Law and causes violations of the False Claims Acts. In the past, qui tam cases involving Anti-Kickback Statute and Stark law violations have resulted in large damages.
Hospital Fraud: Unnecessary Procedures
Another type of hospital fraud case involves billing for unnecessary procedures. In 2015, there was a $250 million settlement against 457 hospitals. The hospital fraud alleged involved implanting cardiac devices into Medicare patients in violation of Medicare requirements. The whistleblower received a large portion of the settlement as an award for reporting healthcare fraud.
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