On November 18, 2009, the U.S. Department of Justice announced that it had reached an agreement with New Jersey based Trinitas Regional Medical Center to resolve allegations in a qui tam lawsuit that the hospital submitted false Medicare claims in violation of the False Claims Act. Besides its regular reimbursement system, Medicare also offers supplemental “outlier payments” to health-care providers in cases where the cost of care is abnormally high. The payments are intended to incentivize providers to treat patients where the cost of care will be unusually expensive. The lawsuit alleged that Trinitas inflated its charges to obtain outlier payments for cases in which the actual cost of care was not unusually high and outlier payments should not have been available. In exchange for bringing the alleged fraud to the government’s attention, the whistleblower will receive approximately $679,000 with interest out of the total settlement.
