NOVEMBER 2, 2023. Putnam Community Medical Center of North Florida, owner of Putnam Community Medical Center, LLC, has agreed to pay a $1 million qui tam settlement. This settlement resolves claims that the medical center violated the False Claims Act by submitting fraudulent claims to Medicare and TRICARE in relation to its now-closed sleep center that allegedly operated without proper physician supervision. TRICARE is a health insurance program which primarily covers active-duty service members and their families, as well as retirees, their families, and survivors. Beneficiaries can receive care from military hospitals or clinics, a civilian provider network, or TRICARE-authorized non-network providers. Plans vary based on location and military status, but it is an important part of American healthcare infrastructure. These allegations were brought to light by a whistleblower, who will receive $300,000 – an impressive 30% of the settlement amount.
From December 2013 to February 2019, Putnam Medical Center, a 99-bed hospital in Palatka, Florida, offered diagnostic testing for patients struggling with different sleep issues and concerns. The now-closed sleep center failed to meet certain Medicare regulations due to the lack of adequate physician supervision. Because of this, the claims filed in relation to the center were alleged to be fraudulent. A U.S. Attorney stressed the importance of the integrity of healthcare programs like Medicare and TRICARE, stating that “Protecting Medicare and TRICARE patients is paramount … This civil settlement demonstrates our continuing commitment to hold accountable those who abuse the nation’s healthcare programs at the expense of the taxpayers.”
This settlement was reached due to the efforts of Williard Revels, a former sleep center employee who blew the whistle on these fraudulent actions. He filed the action under the qui tam provisions of the False Claims Act. These provisions allow private individuals to file actions on behalf of the United States when they have knowledge of fraudulent activities. In return, whistleblowers may receive a portion of any recovery, as Revels did for his work.
Health insurance fraud takes many forms. It may look like attempting to underpay pharmaceutical rebates, prescribing unnecessary tests to patients, accepting or offering kickbacks, or many more illegal acts. No matter what form it takes, fraud and abuse in healthcare that involves reimbursement from government funds may be reportable under the False Claims Act.
If you would like to report healthcare fraud, including Medicare or TRICARE fraud, you can contact attorneys at Tycko & Zavareei LLP. Eva Gunasekera and Renée Brooker are former officials of the United States Department of Justice and prosecuted whistleblower cases under the False Claims Act. Renée served as Assistant Director at the United States Department of Justice, the office that supervises False Claims Act cases in all 94 United States District Courts. Eva was the Senior Counsel for Health Care Fraud. Eva and Renée now represent whistleblowers. For a free consultation, you can contact Renée at [email protected] (tel.: 202-417-3664) or contact Eva Gunasekera at [email protected]. You can also go to Tycko & Zavareei LLP’s website for whistleblowers to learn more at www.fraudfighters.net.