$5.5 million settlement illustrates government’s war on health care fraud

posted on:
September 29, 2015

Lance Gould

In August 2015, two Missouri health care providers agreed to settle an alleged violation of the Federal False Claims Act. Mercy Health Springfield Communities and Mercy Clinic Springfield Communities were accused of conducting improper financial practices. The allegations implied they had a financial structure that rewarded physicians for referring patients to hospitals or other health care providers. This resulted in the organizations allegedly submitting false claims to the Medicare program. In order to settle these alleged violations of the Federal False Claims Act, the two Missouri Hospitals have agreed to pay the United States $5.5 million.

Speaking for the United States, U.S. Attorney Tammy Dickerson of the Western District of Missouri stated, “This settlement protects patients and the public by enforcing the federal protections against illegal profit incentives for physicians. A bonus structure that rewards physicians based on the value of their referrals is detrimental to both the quality and the cost of health care.” Dickerson goes on to say, “Patients deserve assurances that are receiving appropriate medical care, unbiased by hidden incentives. And tax payers deserve assurances that the cost of public health care programs is not inflated by unnecessary procedures and services.”

The government has placed an emphasis on combating health care fraud. The American people ought to be able to trust in medical institutions. People ought to be able to trust not only in the intuition’s quality but also in their integrity. In order help foster that trust, the American Government is aggressively pursuing organizations that engage in conduct that is detrimental to both taxpayers and the medical industry.

A major component of the Government’s war on health care fraud is the incentive for whistleblowers, which is contained in the qui tam provision of Federal False Claims Act. These incentives include 15 percent to 30 percent of the funds the government recovered. For example, this case against Mercy Health Springfield Communities and Mercy Clinic Springfield Communities was filed by a physician, a whistleblower, who is employed by one of the providers. As a reward for doing the right thing, this physician will receive $825,000 from the settlement.

Since January 2009, the United States has recovered more than $24.9 billion through Federal False Claims Act cases and, out of that $24.9 billion, $15.9 billion were 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. There is a contact form on this website, or you may email one of the lawyers on our whistleblower litigation team: Andrew Brashier, Archie Grubb, Larry Golston or Lance Gould.

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