On Oct. 30, the U.S. Department of Justice (DOJ) announced that it was settling one of the largest whistleblower lawsuits in the United States. This suit involved 457 hospitals in 43 states. Seventy settlements were reached amounting to more than $250 million, which also makes this lawsuit one of the most significant recoveries to date. The DOJ alleged that for seven years these hospitals were committing fraud against the Medicare program.
The allegation involved implantable cardioverter defibrillators (ICDs), a device that is implanted and connects to the heart. It works similar to the external defibrillators; however, an ICD is small enough to be implanted. An ICD costs nearly $25,000 and is covered under Medicare if certain conditions are met. An ICD is not allowed to be implanted within 40 days of the patient having a heart attack or within 90 days of the patient having a bypass/angioplasty. The waiting period is designed to give the heart a chance to improve function on its own without the use of an ICD.
The DOJ alleges that these 457 hospitals have been implanting ICDs during the prohibited waiting periods. Therefore, patients who might not have needed ICDs have been receiving ICDs, and Medicare has been paying for them.
In regards to the 70 settlements, Benjamin Mizer, Principal Deputy Assistant Attorney General, stated, “[w]e are confident that the settlements announced today will lead to increased compliance and result in significant savings to the Medicare program while protecting patient health.”
The majority of the settling defendants were named in a whistleblower lawsuit brought under the False Claims Act (FCA). As their reward for helping the government combat health care fraud, these whistleblowers received more than $38 million from the settlements. As this $250-million settlement demonstrates, the government is very serious about combating health care fraud, and the FCA continues to not only be a powerful tool but also a vehicle for private citizens to join the war on fraud and possibly be rewarded for doing so.
Since January 2009, the United States has recovered more than $26.2 billion through FCA cases and, out of that $26.2 billion, $16.4 billion was collected from cases involving fraud against federal health care programs. The whistleblower incentives – rewards – have helped the government (1) detect more fraud, (2) ensure money intended for health care is properly spent on health care, and (3) deter other companies from committing the same fraud.
If you are aware of fraud being committed against the federal or state governments, you could be rewarded for doing the right thing by reporting the fraud. If you have any questions about whether you qualify as a whistleblower then please feel free to contact an attorney at Beasley Allen, for a free and confidential evaluation of your claim.
Source: U.S. Department of Justice