On Monday, April 27, 2015, the Department of Justice (DOJ) announced that The Medical Center of Central Georgia (MCCG), the second largest hospital in Macon, Georgia, agreed to a $20 million settlement to resolve allegations that it violated the False Claims Act (FCA) by overbilling Medicare for unnecessary inpatient care. According to the lawsuit filed by the government, MCCG allegedly charged Medicare for services rendered to patients admitted into the hospital, when less expensive outpatient care would have sufficed. Knowingly billing the government for unnecessary procedures, services, or hospital stays violates the FCA and is considered Healthcare fraud. Additionally, when profits are considered more important than the best interests of patients, trust in the health care system is eroded, and taxpayer dollars are wasted.
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources, and also offers benefits not normally covered by Medicare, like nursing home care and personal care services. When a company or individual knowingly bills the Medicaid or Medicare system for bogus or unnecessary services, it is a violation of the FCA. According to the government, MCCG allegedly continued, for a period of four years between 2004 and 2008, to overbill Medicare for services rendered to patients that qualified for observation or outpatient care, but not for the overnight hospital stays for which Medicare was billed. The government alleged that MCCG’s motive was to increase its revenue, and an investigation into it practices revealed MCCG’s alleged violations.
As part of the settlement agreement, MCCG entered into a corporate integrity agreement (a “CIA”) with the Office of Inspector General of the U.S. Department of Health and Human Services. That CIA requires the company to adhere to the rules and regulations outlined in the agreement for a period of five years.
When a company intentionally ignores laws designed to protect tax payers dollars, and takes advantage of government programs for financial gain, it not only depletes Medicare and Medicaid funds, but it also hurts the people these programs are designed to assist. However, to combat this type of fraud, provisions of the FCA allow any person, who knows of an individual or company that has financially defrauded the federal government, to file a “qui tam” lawsuit to recover damages on behalf of the government. Additionally, a whistleblower who files a case against a company that has committed fraud against the government, may receive an award of up to 30 percent of the settlement.
If you have information concerning a potential case involving Medicare or healthcare fraud, you can help by bringing that information to the attention of the government. 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 U.S. 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.