A registered nurse has taken three different hospitals to court for False Claims Act violations. The woman is listed as a registered nurse in Texas dating back to 1990. She has also earned a law degree and served in high level management positions in various hospitals.
One such position was the director of case management at Christus Health in Corpus Christi Texas. While serving in this role, the nurse reported a billing issue. She stated that the hospital was billing cardiac-blockage-removal procedures as inpatient procedures to Medicare when the procedures should have been billed as outpatient. She contends that this difference resulted in a $10,300 overpayment to the hospital for each procedure. The nurse further stated that she was “rebuffed” when she attempted to resolve the issue.
How do False Claims Act cases work? The False Claims Act states a party is liable if they knowingly submit a false claim to the government or causes another to submit a false claim.
This law also includes a portion referred to as qui tam. Essentially, this part of the law allows civilians to file a lawsuit on behalf of the government against another party that is defrauding the government. The government can then choose to join the lawsuit. If the government joins and the case is successful, the individual that initiated the lawsuit gets a portion of the recovery.
How was this type of case used by the nurse noted above? In the case above, the nurse filed a qui tam lawsuit against the Corpus Christi facility. The facility ultimately agreed to a settlement with the Department of Justice of over $5 million because of these allegations. The nurse received over $1 million for her role in the case.
The nurse took another position at a health facility in Nevada and came across a similar issue. This led to a second qui tam lawsuit. She won again and received $1.7 million as her share. Shortly after this position, she took on a role with a facility in Arizona. Here she allegedly uncovered another billing issue involving outpatient procedures billed as inpatient. This time she will receive $3.3 million from the settlement.
What can health care facilities learn from these cases? Allegations of overbilling Medicare are serious. Defenses are available and prompt action is advisable. Contact an attorney to discuss your options.