Medical professionals including
medical doctors and physicians that blow the whistle on
Medicare fraud and Medicaid fraud will often require
special protection to protect their medical career and
reputation from potential retaliations. By
contacting a medical doctor whistleblower lawyer,
physician whistleblower lawyer, or medical professional
whistleblower lawyer, a potential medical professional
whistleblower can often better protect their career from
retaliation as well as seek large financial rewards for
reporting systematic Medicare fraud and Medicaid fraud.
For more information on a potential
Physician Whistleblower Medicare Fraud Lawsuit, Medical
Doctor Whistleblower Medicare
Fraud Lawsuit, or other Medical Professional
Whistleblower Health Care Fraud Lawsuit, feel free to
contact
Physician Whistleblower Lawyer, Medical Doctor
Whistleblower Lawyer, and Medical Professional Whistleblower Lawyer
Jason Coomer via
e-mail message or use our
submission form to obtain information on a potential
Medical Doctor
Health Care Medical Fraud Whistleblower lawsuit,
Physician Whistleblower Medicare Fraud
Lawsuit,
Hospital Employee Whistleblower Medicare Fraud Lawsuit, or other
Medical Professional Whistleblower Medicare
Billing Fraud Whistleblower Lawsuit.
Medical Doctor Whistleblower Medicare Fraud Lawyers,
Physician Whistleblower Medicare Fraud Lawyers, Medical
Professional Whistleblower Medicare
Fraud
Lawyers, Hospital Employee Whistleblower Billing Fraud
Lawyers, Medical Doctor Whistleblower Medicaid Fraud Lawyers, and
Physician Medicaid Fraud Whistleblower Lawyers
Medicare
fraud and Medicaid fraud are becoming the fastest growing and most
lucrative crimes in the United States. It is
estimated that Medicare fraud and Medicaid fraud costs tax payers
between $100
Billion and $200 Billion each year. As such, the
United States Department of Justice is encouraging Medicare Fraud Whistleblowers
and Medicaid Fraud Whistleblowers with
evidence of systematic Medicare fraud or systematic
Medicaid fraud to step up and blow the whistle
on Medicare fraud and Medicaid fraud.
Further, several Whistleblower Laws
have recently been enacted to strengthen whistleblower
protections as well as increase potential economic
rewards to persons with specialized knowledge of fraud
such as medical doctor whistleblowers, physician
whistleblowers, and other medical professional
whistleblowers. By working through medical doctor
whistleblower lawyers, physician whistleblower lawyers,
and other medical professional whistleblower lawyers, a
medical professional whistleblower can not only better
protect their medical career from potential
retaliations, but also increase their ability to
recover large economic rewards under whistleblower
reward laws.
Medical Doctor Whistleblower Medicare Fraud Lawyer,
Physician Whistleblower Medicare Fraud Lawyer, Medical
Professional Whistleblower Medicare
Fraud
Lawyer, Hospital Employee Whistleblower Billing Fraud
Lawyer, Medical Doctor Whistleblower Medicaid Fraud Lawyer, and
Physician Medicaid Fraud Whistleblower Lawyer
As a result of the large amount of
systematic fraud that is hurting our health care
industry, medical doctors, hospital chief financial officers,
benefit coordinators, Medicare
compliance coordinators, nurses, physicians, coding specialists, Medicare
reimbursement managers, accountants, and other health care
professionals are coming forward and blowing the whistle
on health system fraud and hospital fraud that costs tax
payer hundreds of Billions of dollars. By coming
forward as the original source of specialized
information of Medicare fraud these whistleblowers may receive large economic reward.
However, it is important to understand that the medical
doctor whistleblower, hospital chief financial officer
whistleblower,
benefit coordinator whistleblower, Medicare
compliance coordinator whistleblower, nurse
whistleblower, physician whistleblower, coding
specialist whistleblower, Medicare reimbursement manager
whistleblower, accountant whistleblower, medical billing
professional whistleblower, and other medical
professional whistleblower must be the first to file on the Medicare fraud
and have specialized knowledge of the fraud.
Further, it is important to realize
that once a medical professional has knowledge of
Medicare fraud, not coming forward to report the fraud
can result in potential criminal liability.
Many Large "For Profit" Health Care Providers
Become Medical Assembly Lines for Patients, Provide Mass
One Size Fits All Medical Services for Patients
Regardless of Individual Medical Need, and Commit
Systematic Medicare Fraud
and/or Medicaid Fraud
by Texas Medicare
Fraud Lawyer Jason S. Coomer
In the modern age of mass medicine,
many medical practices have been hijacked by
large "for profit" health care systems
that have turned
traditional medical practices into mass medical
billing systems. In these mass medical billing
systems, medical doctors are no longer in control.
Medical doctors that once knew
their patients and were able to spend
time treating their patients and now but a cog in large "for profit"
billing machines. Medical doctors in some of
these mass billing machines are forced to bill,
examine, diagnose, and treat thousands of patients
in an assembly line system. The medical doctor
and patient are lucky to spend
10 or 15 minutes together. These "for
profit" patient mills often tend to press
medical doctors to provide one size
fits all services despite the individual needs of
the patient.
These mass medical billing
systems also often force highly educated and trained
medical doctors to focus on billing quotas, instead
of focusing on the practice of medicine and what is
best for the patient. In many of these large "for
profit" medical systems, patients are nothing more
than a number or a Medicare number that can be
billed and medical doctors are a employees that are
told how to practice and what services and drugs to
push.
In some large mass medical
billing "for profit" hospitals
and health care systems, patients and medical
doctors are viewed through
their billing departments as ways to make a profit
by billing for expensive and unnecessary
services.
Regardless of the patient's actual needs, the
ability to bill Medicare, Tricare, Medicaid,
insurance, and other third party payers for services becomes a
driving force as to how the medical doctor is
instructed to practice and the patient treated in the
medical system. By maximizing the amount that
can be billed to Medicare or other third party
payers, the large mass medical billing health care provider is able to
maximize their revenue and profits regardless of
what the patient actually needs. In these mass
medical billing systems, the patient's
needs often become secondary to the need to maximize
profits and doctors that don't maximize potential
Medicare billing are punished.
In these mass medical billing
systems, powerful economic
incentives can drive large hospitals and health care
systems to listen to accountant, billing
professionals, and coding analysts over highly
trained physicians and other medical professionals.
Thus, these economic incentives can often create
medical billing fraud including upcoding, double
billing, unnecessary treatments, and phantom
billing.
To combat economic incentives
that are moving medical systems away from the best interests of patients,
several laws have been passed to encourage medical
professionals to blow the whistle on fraudulent
including the
Medicaid Fraud Whistleblower Laws,
Medicare Fraud Whistleblower Laws,
Stark Laws and
Anti-kickback Laws.
Hospital Medicare Fraud Medical Doctor Whistleblower
Lawyer, Nursing Home Medicare Fraud Physician Whistleblower
Lawyer, Physician Whistleblower Medicare Fraud
Lawyer, Hospice Fraud Physician Whistleblower Lawyer, and Home
Health Care Medicare Fraud Physician Whistleblower Lawyer
If you are a hospital
administrator, nursing home administrator,
physician, nurse, respiratory therapist, coder,
accountant, dentist, health care coordinator, coding
specialist, or other health care professional that
is aware of Medicare fraud, it is important that you
report the Medicare fraud. As a Medicare fraud
whistleblower you not only can recover a portion of
the recovery if the fraud is properly reported, but
it can help avoid potential criminal liability.
Medicare fraud lawyer, Jason S. Coomer helps
whistleblowers that are aware of systematic Medicare
fraud including health care providers that are
committing upcoding, illegal kickbacks, charging for
unnecessary services and procedures, charging for
services not provided, double billing, or bill
padding, feel free to contact
Medicare Fraud Lawyer, Jason Coomer with any
questions that you might have.
Medicare Fraud
Lawsuit, Systematic Medicare Fraud
Lawsuit, Medicare
Recipient Whistleblower Lawsuit,
Medicare Fraud Whistleblower Lawsuit, Systematic
Medicaid Fraud Lawsuit,
and Medicare
Compliance Fraud Lawsuit Information
by Texas Medicare
Fraud Lawyer Jason S. Coomer
Medicare
fraud
and Medicaid fraud scams are costing the
United States hundreds of billions of
dollars and are threatening the Medicare benefits
and Medicaid benefits of millions of Americans.
The cost of systematic Medicare fraud and systematic
Medicaid fraud includes nursing homes, home health
care services, hospitals, therapists, dentists, and
other health care providers that systematically and
knowingly commit upcoding Medicare fraud schemes, double billing
Medicare fraud schemes,
unnecessary service Medicare Fraud schemes, and
other fraudulent Medicare billing schemes. By
billing for services not provided or
needed, many fraudulent health care providers have
found it extremely profitable to exploit the current
Medicare and Medicaid system.
To
combat Medicare Billing Fraud Scams and Medicaid
Billing Fraud Scams, the United States government
has amended the Federal False Claims Act to
encourage more Medicare Fraud whistleblowers through
economic incentives to step
up and blow the whistle on significant Medicare Fraud
and Medicaid Fraud. Medicare Fraud Whistleblowers
and Medicaid Fraud Whistleblowers that are the original source of
specialized knowledge of significant Medicare Fraud
or systematic Medicaid Fraud can make
substantial recoveries if they are the first to file
a successful qui tam claim under the Federal False
Claims Act.
If you have evidence of
significant systematic Medicare Fraud or systematic
Medicaid Fraud, it is important that you properly
report that the systematic Medicare fraud or
systematic Medicaid fraud, so that you can
potentially recover a portion of the money recovered
from the fraudulent health care provider.
There are several keys to a
successful False Claims Act Qui Tam Whistleblower action
including 1) obtaining original and specialized
information of the fraud, 2) being the first to file
regarding the specific fraud, and 3) protecting the
whistleblower for retaliation.
Original and Specialized Information of Fraud
is Essential for Medicare Coding Whistleblower
Lawsuits,
Medicare Reimbursement Whistleblower Lawsuits,
Medicare Compliance Whistleblower Lawsuits, and Medicare
Marketing Fraud and Kickback Lawsuits
As insiders it is common for hospital
administrators, doctors, nurses, accountings, coders,
billing specials, compliance specialist, and other
health care professionals to have
specialized knowledge of Medicare fraud, systematic
Medicare Fraud, and fraudulent Medicare schemes. As such, it is important for
the systematic Medicare fraud
whistleblowers to obtain and preserve evidence of the
Medicare fraud. Whether this evidence is in
e-mail messages, memos, marketing plans, marketing
materials, recordings, or other documents, it is
important for the whistleblower to have evidence of the
systematic Medicare fraud. It is also often helpful to have
fellow whistleblowers that can help build the Medicare
Fraud or systematic Medicare Fraud case.
Being the First to File on the Fraud is
Essential for Recovery Under the False Claims Act and
can Prevent Potential Criminal Liability in Medicare
Fraud Scams,
Medicare Reimbursement Fraud Scams,
Systematic Medicare Fraud Scams, and Medicare
Fraud Kickback Scams
It is also essential to not delay in
coming forward with a False Claim Act Medicare Fraud
Whistleblower Action as
the first whistleblower to file is eligible to be a relator and make a large recovery for exposing the
fraud. Additionally, when the fraudulent scheme is
exposed, the people that kept the fraud secret can
sometimes be found liable for criminal activity for not
exposing the fraud that was being committed and further
be held liable for continuing criminal activity.
Medicare Fraud
Lawsuit Information, Texas Medicare Fraud
Whistleblower Lawsuit Information, Texas False Medicare
Billing Lawsuit Information,
Medicare Coding Fraud Whistleblower Lawsuit Information,
and Medicare
Compliance Fraud Lawsuit Information by Texas Medicare
Fraud Lawyer
Texas Medicare Fraud Lawyer,
Jason S. Coomer, is working with Medicare Fraud
Whistleblowers to expose Medicare fraud and blow the
whistle on criminals that are fraudulently stealing
from the United States and the Medicare program.
Below are several press releases regarding Medicare
Fraud.
More Than $1 Billion Recovered by Justice
Department in Fraud and False Claims in Fiscal Year
2008 More Than $21 Billion Recovered Since 1986
WASHINGTON – The United States
secured $1.34 billion in settlements and judgments
in the fiscal year ending Sept. 30, 2008, pursuing
allegations of fraud against the federal government,
the Justice Department announced today. This brings
total recoveries since 1986, when Congress
substantially strengthened the civil False Claims
Act, to more than $21 billion.
"Now, more than ever, it is
crucial that taxpayer dollars aren't lost to fraud,"
said Gregory G. Katsas, Assistant Attorney General
for the Department’s Civil Division. "The billion
dollars collected this year is only part of the
story. By rooting out fraud and vigorously pursuing
it, the Department, with the help of concerned
citizens who report fraud in hotline calls and in
qui tam complaints, undoubtedly saves the country
many times that amount in aborted schemes and
misconduct."
Assistant Attorney General Katsas
also paid tribute to Senator Charles Grassley of
Iowa and Representative Howard L. Berman of
California who sponsored the 1986 amendments to the
False Claims Act, the government's primary weapon to
fight government fraud. "Without this important
legislation strengthening the Act and, in
particular, the qui tam provisions which encourage
private citizens to uncover government fraud, such
recoveries would not have been possible."
Almost 78 percent of this year’s
recoveries are associated with suits initiated by
private citizens (known as "relators") under the
False Claims Act's qui tam provisions. These
provisions authorize relators to file suit on behalf
of the United States against those who have falsely
or fraudulently claimed federal funds. Such cases
run the gamut of federally funded programs from
Medicare and Medicaid to defense procurement
contracts, disaster assistance loans and
agricultural subsidies. Persons who knowingly make
false claims for federal funds are liable for three
times the government’s loss plus a civil penalty of
$5,500 to $11,000 for each claim.
Relators recover 15 to 25 percent
of the proceeds of a successful suit if the United
States intervenes in the qui tam action, and up to
30 percent if the government declines and the
relator pursues the action alone. In fiscal year
2008, relators were awarded $198 million. (This
figure does not include relator shares awarded after
Sept. 30, 2008.)
As in the last several years,
health care accounted for the lion's share of fraud
settlements and judgments–$1.12 billion. This number
includes both qui tam claims and those initiated by
the United States. The Department of Health and
Human Services reaped the biggest recoveries,
largely attributable to its Medicare program and the
federal/state Medicaid program which funds health
care for the needy. Recoveries were also made by the
Office of Personnel Management which administers the
Federal Employees Health Benefits Program, the
Department of Defense for its TRICARE insurance
program, the Department of Veterans Affairs and
others.
The largest health care
recoveries came from pharmaceutical companies and
related entities. Settlements with Cephalon Inc.,
Merck & Co. and CVS Caremark Corp. accounted for
more than $640 million. In addition to federal
recoveries, these pharmaceutical fraud cases
returned $430 million to state Medicaid programs.
The Civil Division’s
investigation of the pharmaceutical industry is part
of a Department-wide effort. Typical allegations
include "off-label" marketing, which is the illegal
promotion of drugs or devices that are billed to
Medicare and other federal health care programs, for
uses that were neither found safe and effective by
the Food and Drug Administration nor supported by
the medical literature; paying kickbacks to
physicians, wholesalers and pharmacies to induce
drug or device purchases; establishing inflated drug
prices knowing that federal health care programs use
these prices to reimburse providers, then marketing
the "spread" between the federal reimbursement and
the provider’s lower cost to induce drug purchases;
and knowingly failing to report the company’s true
"best price" for a drug to reduce rebates owed to
the Medicaid program.
The Department also collected
$133 million in defense procurement fraud. Defense
contract recoveries included a $53 million
settlement with Pratt & Whitney, a division of
United Technologies Corporation, and PCC Airfoils
LLC, a subsidiary of Precision Castparts
Corporation. The settlement resolved allegations
that Pratt & Whitney and PCC Airfoils knowingly
submitted false claims to the Air Force for
defective turbine blades sold to the government to
retrofit the F100-PW-220 engines in F-16 and F-15
aircraft. This case was pursued as part of a
National Procurement Fraud initiative, launched in
October 2006, to promote the early detection,
identification, prevention and prosecution of
procurement fraud.
FACT SHEET: SIGNIFICANT
RECOVERIES IN FISCAL YEAR 2008
Among the Department’s most
significant settlements and judgments in fiscal year
2008 were:
* $361.5 million from Merck &
Company to resolve allegations that the
pharmaceutical manufacturer knowingly failed to pay
proper rebates to Medicaid and other government
health care programs, and paid kickbacks to health
care providers to induce them to prescribe the
company’s products. The settlement resulted from two
lawsuits brought under the qui tam provisions of the
False Claims Act.
In the first, which accounted for
$221.9 million of the $361.5 settlement, a former
Merck employee alleged that the company violated the
Medicaid Rebate Statute by providing deep discounts
to hospitals that used its drugs Zocor and Vioxx in
place of competitors’ brands, without reporting
those discounts and other cost information to
reflect its "best price," as required by the statute
to ensure that Medicaid obtains the benefit of the
same price concessions other purchasers enjoy. This
suit also alleged that Merck paid kickbacks to
physicians, disguised as fees for training,
consultation, and market research, to induce them to
prescribe its drugs, also contrary to law. The
United States paid the relator $46.6 million as his
share of the settlement under the False Claims Act’s
qui tam provisions. In addition to the federal
recovery, Merck paid $162 million to state Medicaid
programs.
In the second lawsuit, which
accounted for the remaining $139.6 million of the
settlement, a physician alleged that Merck provided
deep discounts to hospitals to induce them to
administer its antacid, Pepcid, as a means to boost
sales through continued use after the patient’s
discharge. The suit went on to allege, similar to
the first suit, that Merck knowingly failed to
report these discounts as required by the Medicaid
Rebate Statute, which resulted in illegal and
inflated claims to federal and state Medicaid
programs. In addition to paying the United States
$139.5 million in federal claims, Merck paid $114
million to settle state Medicaid claims. The relator
received $24 million as his federal share of the
settlement and an additional sum for the state
recoveries. Merck also entered into a Corporate
Integrity Agreement with the Inspector General of
the Department of Health and Human Services (HHS) to
ensure compliance with federal health insurance
programs in the future.
Department of Justice Office of Public Affairs
FOR IMMEDIATE RELEASE Tuesday, January 4, 2011 Seven
Hospitals in Six States to Pay U.S. More Than $6.3
Million to Resolve False Claims Act Allegations Related
to Kyphoplasty
WASHINGTON – Seven hospitals located
in Florida, Mississippi, Texas, South Carolina, North
Carolina and Alabama have agreed to pay the United
States a total of more than $6.3 million to settle
allegations that the health care facilities submitted
false claims to Medicare, the Justice Department
announced today.
The settlements resolve allegations
that these hospitals overcharged Medicare between 2000
and 2008 when performing kyphoplasty, a
minimally-invasive procedure used to treat certain
spinal fractures that often are due to osteoporosis. In
many cases, the procedure can be performed safely as a
less costly out-patient procedure, but the government
contends that the hospitals performed the procedure on
an in-patient basis in order to increase their Medicare
billings.
"Hospitals that participate in the
Medicare program must bill for their services accurately
and honestly," said Tony West, Assistant Attorney
General for the Department’s Civil Division. "The
Department of Justice is committed to ensuring that
Medicare funds are expended appropriately."
"These settlements show the
continuing commitment by the U.S. Attorney’s Office to
investigate and recover any improper billings for
kyphoplasty procedures which the hospitals
inappropriately classified as inpatient, rather than
outpatient," said William J. Hochul Jr., U.S. Attorney
for the Western District of New York. "These actions not
only protect taxpayers and the integrity of the Medicare
program in the short term, they will in the long run
help ensure optimal care for Medicare beneficiaries, by
insisting that medicine, and not money, be used to
determine the best course medical decision for a given
case."
The settling facilities include the
following: Lakeland Regional Medical Center, Lakeland,
Fla. ($1,660,134.49); The Health Care Authority of
Morgan County – City of Decatur dba Decatur General
Hospital, Decatur, Ala. ($537,892.88); St.
Dominic-Jackson Memorial Hospital, Jackson, Miss.
($555,949.35); Seton Medical Center, Austin, Texas
($1,232,955.91); Greenville Memorial Hospital,
Greenville, S.C. ($1,026,764.01); Presbyterian
Orthopaedic Hospital, Charlotte, N.C.($637,872.57); and
The Health Care Authority of Lauderdale County and the
City of Florence, Ala., dba the Coffee Health Group, fka
Eliza Coffee Memorial Hospital ($676,038.00).
The settlements with these facilities
follow the settlements that the government reached in
May 2009, September 2009, and May 2010 with 18 other
hospitals for kyphoplasty-related Medicare claims, as
well as the government’s May 2008 settlement with
Medtronic Spine LLC, corporate successor to Kyphon Inc.
Medtronic Spine paid $75 million to resolve allegations
that the company defrauded Medicare by counseling
hospital providers to perform kyphoplasty procedures as
an in-patient procedure, even though the
minimally-invasive procedure should have been done in
many cases as an out-patient procedure.
All of the settling facilities were
named as defendants in a lawsuit filed under the False
Claims Act in 2008 in federal district court in Buffalo,
New York by Craig Patrick and Charles Bates. The qui
tam, or whistleblower, provisions of the Act permit
private citizens, called "relators," to file lawsuits on
behalf of the United States and share in any recovery.
Mr. Patrick of Hudson, Wis., is a former reimbursement
manager for Kyphon, and Mr. Bates was formerly a
regional sales manager for Kyphon in Birmingham, Ala.
The relators will receive a total of approximately $1.1
million as their share of the settlement proceeds.
"Hospitals overcharging Medicare take
critically needed resources necessary to provide quality
care and drive up health care costs," said Daniel R.
Levinson, Inspector General for the U.S. Department of
Health and Human Services. "When Medicare and taxpayers'
dollars are threatened, OIG and its federal partners
will hold perpetrators accountable."
Assistant Attorney General West noted
that the settlements with these hospitals were the
result of a coordinated effort among the Justice
Department’s Civil Division, the U.S. Attorney’s Office
for the Western District of New York, and the Department
of Health and Human Services’ Office of Inspector
General and Office of Counsel to the Inspector General.
This resolution is part of the
government’s emphasis on combating health care fraud and
another step for the Health Care Fraud Prevention and
Enforcement Action Team (HEAT) initiative, which was
announced by Attorney General Eric Holder and Kathleen
Sebelius, Secretary of the Department of Health and
Human Services in May 2009. The partnership between the
two departments has focused efforts to reduce and
prevent Medicare and Medicaid financial fraud through
enhanced cooperation. One of the most powerful tools in
that effort is the False Claims Act, which the Justice
Department has used to recover approximately $4.2
billion since January 2009 in cases involving fraud
against federal health care programs. The Justice
Department's total recoveries in False Claims Act cases
since January 2009 have topped $6.8 billion.
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY
SETTLED HCA INVESTIGATION NETS RECORD TOTAL OF $1.7
BILLION
WASHINGTON, D.C. - HCA Inc. (formerly
known as Columbia/HCA and HCA - The Healthcare Company)
has agreed to pay the United States $631 million in
civil penalties and damages arising from false claims
the government alleged it submitted to Medicare and
other federal health programs, the Justice Department
announced today.
This settlement marks the conclusion
of the most comprehensive health care fraud
investigation ever undertaken by the Justice Department,
working with the Departments of Health and Human
Services and Defense, the Office of Personnel Management
and the states. The settlement announced today resolves
HCA's civil liability for false claims resulting from a
variety of allegedly unlawful practices, including cost
report fraud and the payment of kickbacks to physicians.
Previously, on December 14, 2000, HCA
subsidiaries pled guilty to substantial criminal conduct
and paid more than $840 million in criminal fines, civil
restitution and penalties. Combined with today's
separate administrative settlement with the Centers for
Medicare & Medicaid Services (CMS), under which HCA will
pay an additional $250 million to resolve overpayment
claims arising from certain of its cost reporting
practices, the government will have recovered $1.7
billion from HCA, by far the largest recovery ever
reached by the government in a health care fraud
investigation.
"Health care providers and
professionals hold a public trust, and when that trust
is violated by fraud and abuse of program funds, and by
the payment of kickbacks to the physicians on whom
patients and the programs rely for uncompromised medical
judgment, health care for all Americans suffers," Robert
D. McCallum, Jr., Assistant Attorney General for the
Civil Division said. "This settlement brings to a close
the largest multi-agency investigation of a health care
provider that the United States government has ever
undertaken and demonstrates the Department of Justice's
ongoing resolve and commitment to pursue all types of
fraud on American taxpayers, and health care program
beneficiaries."
"Let this case be a continuing
reminder to all that in the fight against health care
fraud this office will not be deterred," said Acting
Principal Deputy Inspector General Dara Corrigan.
“Medicare dollars paid to provide ever more expensive
health care services to the country's taxpayers should
never be fraudulently diverted. This is our job and our
trust and we take these duties very seriously," Corrigan
concluded.
This latest settlement resolves fraud
allegations against HCA and HCA hospitals in nine False
Claims Act qui tam or whistleblower lawsuits pending in
federal court in the District of Columbia. Under the
federal False Claims Act, private individuals may file
suit on behalf of the United States and, if the case is
successful, may recover a share of the proceeds for
their efforts. Under the settlement, the whistleblowers
will receive a combined share of $151,591,500, the
highest combined qui tam award ever paid out by the
government.
"We are grateful for the assistance
given by the whistleblowers over the course of the past
nine years of investigation and litigation,” McCallum
said. “And we are proud of the work of government
personnel as well as counsel for the whistleblowers, who
together pursued these matters through investigation and
strenuous litigation. This result demonstrates the
commitment of the Department to the qui tam statute and
that the statute works as Congress intended."
Under the first of three agreements
announced today, which becomes effective upon the
court's dismissal of the lawsuits, HCA will pay nearly
$620 million to resolve eight whistleblower lawsuits in
which the government had intervened alleging that HCA
systematically defrauded Medicare, Medicaid and other
federally funded health care programs through schemes
dating back to the late 1980s. HCA will pay an
additional $11 million to resolve separate allegations
of improper HCA billing practices.
The settlement requires HCA to pay:
* $356 million to resolve
whistleblower lawsuits alleging that HCA engaged in a
series of schemes to defraud Medicare, Medicaid and
TRICARE, the military’s health care program, through
hospital cost reports, the year end claims submitted by
hospitals to the government to reconcile payments
received throughout the year with amounts they claim are
actually owed. In 2001, a subsidiary of Nashville-based
HCA, Columbia Management Companies, Inc., pled guilty in
the Middle District of Florida to related charges on
eight counts of making false statements to the United
States and paid $22.6 million in criminal fines. An
additional amount of $20 million of the settlement is
being paid toward a resolution of cost reporting fraud
allegations pursued separately by James Alderson and
John Schilling, the relators who filed the lawsuits. In
total, the two relators are to receive a total of $100
million as their statutory share of the settlement. *
$225.5 million to resolve lawsuits alleging that HCA
hospitals and home health agencies unlawfully billed
Medicare, Medicaid and TRICARE for claims generated by
the payment of kickbacks and other illegal remuneration
to physicians in exchange for referral of patients. In
2001, Columbia Management Companies, Inc., pled guilty
to one count of conspiracy to pay kickbacks and other
monetary benefits to doctors in violation of the
Medicare Antikickback Statute and paid a $30 million
criminal fine. Dr. James Thompson, a doctor who filed
suit against the company in 1995, will receive $41.5
million as his statutory share of the settlement. Gary
King, a former HCA employee, will receive $5 million and
Ann Mroz, a former HCA nurse, will receive a share of
$837,500. * $17 million to resolve allegations that
certain company-owned hospitals billed Medicare for
unallowable costs incurred by a contractor that operated
HCA wound care centers, and for a non-covered drug that
the contractor manufactured and sold to hospital
patients. The 2001 Columbia Management Companies' guilty
plea concerning cost report fraud included a charge
related to wound care center costs. HCA's wound care
center management contractor, Curative Healthcare
Services, Inc., previously paid $16.5 million to resolve
related allegations pending at one time in these same
lawsuits. Joseph "Mickey" Parslow, a former HCA
financial officer, will receive $2,990,000 and Francesco
Lanni, a former Reimbursement Manager at the Wound Care
Center at New York Methodist Hospital in Brooklyn, New
York, will receive a share of $680,000. * $5 million to
resolve allegations concerning the transfer of patients
from HCA facilities to other facilities and the claiming
of excessive costs for those transfers. * $5 million to
resolve allegations that HCA's Lawnwood Regional Medical
Center in Fort Pierce, Florida submitted false claims in
Medicare cost reports by inflating its entitlement to
funds to treat indigent patients and by shifting
employee salary costs in order to increase its
reimbursement from the federal health care program. *
$950,000 to settle allegations made by Michael Marine
that HCA improperly shifted its home office costs to
hospitals. Marine will receive a share of $116,500.
Today's settlement agreement
incorporates the terms of a Corporate Integrity
Agreement executed by HCA and the Office of the
Inspector General, Department of Health and Human
Services in December 2000 that obligated the company to
engage in significant and comprehensive compliance
efforts into 2009.
In a separate agreement, HCA agreed
to pay $1.5 million to resolve allegations that an
Atlanta, Georgia hospital, West Paces Medical Center,
paid kickbacks for the referral of diabetes patients.
Those allegations had been pursued since 1996 by a
whistleblower in a case in which the United States had
declined to intervene, captioned U.S. ex rel. Pogue v.
American Healthcorp, Inc. et al.. Pogue, a former
employee of a co-defendant in the case, Diabetes
Treatment Centers of America, will receive a share of
$405,000 from the HCA settlement. Pogue continues to
litigate claims against his former employer and a group
of Atlanta physicians.
Additionally, a state negotiating
team appointed by the National Association of Medicaid
Fraud Control Units has reached agreement with HCA to
resolve related issues with affected state Medicaid
plans for $17.5 million, representing direct state
losses. The terms of that agreement are being finalized
by the parties and are not part of today's settlement.
Today's administrative agreement
between HCA and CMS will require HCA to pay CMS $250
million in order to resolve claims they maintained
against each other arising from HCA's hospital cost
reports and home office cost statements for cost
reporting periods ending July 31, 2001. These claims
resulted from HCA cost reports that were not processed
since 1997 as a result of the government's
investigation.
Federal False Claims Act Whistleblower Lawyer,
Medicare Fraud Whistleblower Lawyer, Medicaid Fraud
Whistleblower Lawyer, Off Label Marketing Lawyer, False
Medicare Billing Fraud Lawyer, and Texas Qui Tam Lawyer
(Medicaid Fraud, Contractor Fraud, and Medicare Fraud
Lawyer)
As a Texas Federal False Claims Act
Whistleblower Lawyer Jason Coomer handles Medicare fraud
lawsuits, Medicaid fraud lawsuits, defense contractor fraud
lawsuits, securities fraud bounty actions, Medicare fraud
whistleblower lawsuits, dentist CHIP fraud and Medicaid
fraud lawsuits, IRS fraud lawsuits, Texas breach of
fiduciary duty lawsuits, and other Qui Tam lawsuits.
He also works with other Medicare fraud lawyers and False
Claims Act lawyers throughout Texas and the United States on
large False Claims Act Lawsuits.
For more information on False Claim Act
Lawsuits, please go to the following web pages:
Medicare Recipient Whistleblower Lawsuit, Medicare
Recipient Medicare Fraud Lawyer, Medicare Recipient
Fraud
Lawyer, and
Medicare Fraud Medicare Recipient Whistleblower Lawyer
(Texas
Medicare Fraud Lawyer Jason S. Coomer)
Medicare Recipient Whistleblowers may
also be a relator that discovers systematic
Medicare fraud and receive a large Medicare fraud
whistleblower recovery from the government. The
Medicare recipient must 1) obtain original and
specialized information of significant fraud and 2) be
the first to file regarding the specific Medicare fraud
to recover a
large reward for reporting the fraud. Follow this
link for
Medicare Recipient Whistleblower Lawsuit Information.
Medicare Coding Whistleblower
Protection,
Medicare Reimbursement Whistleblower Protection,
Medicare Compliance Whistleblower Protection, and Medicare
Hospital Executive Whistleblower Protection under the
Federal False Claims Act
It is also important to understand
potential whistleblower protections under the False
Claims Act and to discuss with an attorney how to
prepare for potential retaliation or aggressive attacks
by the employer or contractor. For more
information on this topic please go to the following web
page on
False Claims Act Lawsuit Whistleblower Protections.
Medical Doctor Whistleblower Medicare Fraud Lawyers,
Physician Whistleblower Medicare Fraud Lawyers, Medical
Professional Whistleblower Medicare
Fraud
Lawyers, Hospital Employee Whistleblower Billing Fraud
Lawyers, Medical Doctor Whistleblower Medicaid Fraud Lawyers, and
Physician Medicaid Fraud Whistleblower Lawyers
Large health care companies that are
committing Medicare fraud scams are being
brought to justice by whistleblowers and law
enforcement.
Medicare Fraud
Medical Doctor Whistleblower
Lawyer Jason Coomer works
with other powerful Medicare fraud phyisican
whistleblower lawyers to
help Medicare fraud physician whistleblowers blow the whistle on
systematic Medicare fraud.
He works with San Antonio Medicare Fraud Medical Doctor
Whistleblower Lawyers, Dallas
Medicare Fraud Physician Whistleblower
Lawyers, Houston Medicare Fraud Doctor Whistleblower Lawyers, El Paso Medicare
Fraud Medical Doctor Whistleblower Lawyers, and other
Texas
Medicare Fraud Medical Professional Whistleblower
Lawyers as well as with Medicare Fraud Medical Doctor
Whistleblower Lawyers throughout the
nation to blow the whistle on fraud that hurts the United
States.
If you are a medical professional and
are aware of systematic
Medicare fraud and are the original source knowledge of
Medicare Fraud, it is important
that you are the first to step forward to blow the
whistle on the systematic Medicare fraud. If you are a
Medicare Fraud Medical Professional Whistleblower that has evidence of a
fraudulent Medicaid billing scam, a Medicare kickback
scam,
Medicaid kickbacks, or other systematic Medicare fraud, feel free to
contact Medicare Fraud Medical Doctor Whistleblower Lawyer
and Medical Professional Whistleblower Lawyer
Jason Coomer via e-mail message or our
submission form.
