False Claims Act/Qui Tam

This blog is about qui tam, a  lawsuit brought under the False Claims Act by a private plaintiff on behalf of the Federal or State Government (rather than by the Government itself). The False Claims Act was originally enacted by Congress in 1863, as a response to widespread abuses by government contractors against the Union Army during the Civil War. The qui tam provisions are now used widely and this blog is intended to keep readers up to date with all qui tam related news and to provide commentary when warranted.  This blog also contains an array of laws and regulations concerning qui tam set out in an easy to read format.

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Health

Inflated Cost Reports Cost California Hospital Over $2 Million to Settle False Claims Act Allegations

by Nolan and Auerbach on April 30, 2007

On April 20, 2007, the Loma Linda Behavioral Medicine Center paid the United States government in excess of $2 million to settle allegations of overbilling from 1992-1996.  The settlementis the result of a lawsuit filed by a whistleblower under the False Claims Act.  The lawsuit was originally filed in 1998 by a former employee of Healthcare Financial Advisors (HFA), a consulting firm that assists hospitals in preparing cost reports that are submitted to insurers.  The lawsuit alleged that Healthcare Financial Advisors prepared for clients two costs reports; one which was inflated and sent to Medicare and another one designed for internal use only, that accurately reflected the amount of reimbursement the hospital should have received from Medicare.  It should be noted that seven defendants thus far have settled the HFA whistleblower lawsuit, paying approximately $55 million to the government. (Jackson Memorial Hospital in Miami, Florida more than $14 million; St. Elizabeth Regional Medical Center in Lincoln, Nebraska more than $4 million, Lovelace Health System, a wholly owned subsidiary of Cigna Corp. based in Albuquerque, New Mexico, paid $24.5 million in 2002; St. Joseph’s Hospital in Houston, Texas, paid the government $1.5 million in 2002; Eisenhower Medical Center, located in Rancho Mirage, Calif., paid $8 million in 2005 and HealthSouth Bakersfield Rehabilitation Hospital in Bakersfield, Calif., paid $740,000 in 2005).

To read more click here and here or to learn more on cost report fraud click on this link.

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Cost Report Fraud Allegations Cost Baptist Medical and Integris Health $12.2 Million

by Nolan and Auerbach on December 4, 2006

A former contractor of Integris blew the whistle on Integris Health, Inc., alleging that it was submitting inflated claims to Medicare. The complaint stated that Integris sought payment from Medicare for post and non-transplant related costs that Integris knew were not reimbursable under the Medicare program. In addition,the Complaint alleged that Integris claimed Medicare reimbursement for liver and heart organ acquisition costs related to transplant patients who were not Medicare beneficiaries. The whistleblower will receive $2.3 million as a share of the recovery under the False Claims Act. Integris Baptist Medical Center, a not-for-profit health organization, is located in Oklahoma City, Oklahoma and operates the largest Medicare certified Heart, Liver and Kidney transplant program in the state of Texas. Integris Health, Inc. is the parent corporation for Integris Baptist Medical Center.

To read more on this article click here.

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