Morton Plant Mease Health Care Inc. and its affiliated hospitals will pay more than $10 million to the federal government to resolve allegations that they submitted false claims to Medicare.

Randi Ferrare, a former employee who prompted the government’s investigation, will receive a $1.8 million reward as her share of the settlement.  Ms. Ferrare is entitled to the reward under the qui tam or whistleblower provisions of the False Claims Act.

The government’s press release announcing the settlement calls the False Claims Act “one of the most powerful tools” in the battle against health care fraud.

The settlement resolves allegations that the hospitals billed interventional cardiac and vascular procedures as inpatient care when those services should have been billed as less costly outpatient care.

Most interventional cardiology and vascular procedures are classified as minimally invasive because they do not require an instrument to enter the body or large incisions. They usually involve the insertion of a catheter into a small incision in the upper leg.  The catheter is guided toward the heart or vascular area through the use of real-time X-ray.

The whistleblower in this case is a former Director of Health Management Services at Morton Plant Hospital.  She brought her concerns to a lawyer who helped her prepare a complaint and disclosure statement describing the evidence of false claims that were submitted to Medicare.  After reviewing these materials and conducting an investigation, the U.S. Attorney decided to pursue the case and ultimately negotiated the settlement.

Billing lower cost outpatient procedures as more expensive inpatient procedures is just one of many ways false claims can be submitted to Medicare.  Other types of Medicare fraud involves “upcoding” (using a more expensive diagnostic code than the procedure actually justified), billing for services or treatments that were not medically necessary, creating false medical records, and billing for services that involved the payment of kickbacks to referring physicians.

If you are aware that false claims are being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately to protect your rights.  To arrange a free and confidential consultation by phone or in person, call my office today at (917) 652-6504 or click here to contact me via email.

John Howley, Esq.

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