A whistleblower lawsuit alleging a South Carolina hospital submitted false claims to the Medicare program for various treatments was settled this week for more than $7 million.
Linda Jainniney sued her former employer, AnMed Health of Anderson, on behalf of the U.S government under the whistleblower provisions of the False Claims Act. U.S. Department of Justice (DOJ) officials investigated her accusations and chose to intervene in the suit.
The whistleblower suit alleged that AnMed Health billed Medicare for radiation oncology services when a qualified practitioner was not available to provide assistance and direction throughout the radiation procedure, as Medicare regulations require.
The settlement also resolves allegations that AnMed systematically billed Medicare for services provided at a minor-care clinic as if they were provided by an Emergency Department, and then billed Emergency Department services as if they were provided by a physician when those services were actually provided by mid-level providers.
Federal prosecutors alleged these billing practices resulted in higher Medicare reimbursements.
“Our goal in pursuing Medicare fraud is not only to protect taxpayers, but also to ensure that Medicare beneficiaries receive the quality care they deserve,” said Barbara Bowens of the U.S. Attorney’s Office for the District of South Carolina.
U.S. Attorney John Horn said the AnMed case was “another example of how the False Claims Act whistleblower provisions help protect the public’s interest.”
“It also reflects our ongoing commitment to safeguard our federal health care programs and the vital care that they provide,” he added.
Ms. Jainniney’s whistleblower allegations were investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Attorney’s Office for the District of South Carolina, and the Department of Health and Human Services Office of the Inspector General. Ms. Jainniney filed her whistleblower complaint in a North Georgia federal court.
Whistleblowers whose False Claims Act cases lead to a recovery for the U.S. government are awarded between 15 and 25 percent of the total recovery or as much as 30 percent if the U.S. opts to not intervene. Ms. Jainniney will receive $1.2 million (about 17 percent) as a whistleblower award.
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Are you aware of fraud being committed against the federal government, or a state government? If so, you may be protected and rewarded for doing the right thing by reporting the fraud. If you have any questions about whether you qualify as a whistleblower, please 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: Archie Grubb, Larry Golston, Lance Gould or Andrew Brashier.
Source: U.S. Department of Justice