On September 21, 2015, the Department of Justice (DOJ) announced that Adventist Health System, a nonprofit healthcare organization that operates hospitals and other healthcare facilities in ten states, agreed to pay the federal government $115 million to settle allegations that it violated the False Claims Act (FCA) by improperly compensating employed physicians for referring patients to its facility and by knowingly committing healthcare fraud when it miscoded claims sent to Medicaid and Medicare for reimbursement of physician services. Under the settlement, several states will share in an additional $3.7 million. The lawsuit was filed by three former employees of Adventist Health System as qui tam whistleblowers case under the FCA.
The Anti-Kickback Statue and the Stark Statute are federal laws designed to discourage unlawful relationships between healthcare facilities and its practicing physicians. The These laws make it illegal for a health care company to compensate physicians for referring patients to its hospitals or other facilities. It is also unlawful for physicians to accept any form of bribe or compensation from health care facilities for patient referrals or any practice that involves kickbacks. However, according to the qui tam lawsuit filed by three former employees of Adventist Health Care on behalf of the government, Adventist Health Care System allegedly encouraged and maintained improper relationships with its employed physicians by providing them with additional compensation or “bonuses” based on a formula it devised for the number of referred patients. In addition, the federal government claims that Adventist Health Care knowingly miscoded bills submitted Medicaid and Medicare for services rendered by these physicians – services that did not actually take place. This scheme was allegedly devised as a backdoor way of compensating physicians for patient referrals, which is against the law and a violation of the FCA.
Whenever a health care facility commits healthcare fraud –like that alleged in this case, taxpayers are affected, the trust of the patients compromised, and the health and well-being of the patients is jeopardized. For this reason, the government will award any person up to 30% of the funds recovered through the filing of a qui tam lawsuit. While it has not been publicly announced what amount was paid to the whistleblowers in the Adventist lawsuit, it likely was in excess of $17 million.
If you know of any person or organization committing healthcare fraud by overbilling Federal Health Care program, such as Medicare, Medicaid, or Tricare, do not hesitate to take action. It is possible that you might be able to bring your own qui tam lawsuit under the False Claims Act, acting as a whistleblower on behalf of the US government. Before filing your lawsuit, be sure to consult with an attorney familiar with the intricacies of the False Claims Act and qui tam lawsuits, as these attorneys are best equipped to help protect your rights and help you gain your share of any monetary reward from a potential settlement.
If you would like to consult with one of our False Claims Act attorneys please fill out our Confidential Case Evaluation form, or call (202) 973-0900 to speak with a lawyer at the law office of Tycko & Zavareei LLP.