Children's Hospital Allegedly Filed False Cost Reports to Increase Reimbursement Rates from Medicare and Medicaid.
James A. Roark, Sr., a former employee of Children's National Medical Center, will receive a $1.9 million whistleblower reward for coming forward with evidence that his former employer submitted false cost reports to the government in order to increase its reimbursements from Medicare and Medicaid.
The whistleblower reward resulted from a settlement agreement in which the hospital agreed to pay $12.9 million in restitution to the government.
The whistleblower claimed that the hospital filed false cost reports that misstated its overhead, which resulted in higher reimbursement rates and overpayments from Medicare and Medicaid.
According to the settlement agreement, the hospital also misreported its available bed count on an application for the Children's Hospitals Graduate Medical Education (CHGME) Payment Program. The CHGME Payment Program provides federal funds to freestanding children's hospitals to help them maintain their graduate medical education programs that train pediatric and other residents.
Under the False Claims Act, an individual citizen may commence a whistleblower or qui tam lawsuit on behalf of the government to recover money for false claims submitted to Medicare, Medicaid, and other government programs. The qui tam lawsuit is filed "under seal" (in secret) and the whistleblower's evidence is given to the government, which then must conduct an investigation. If the government recovers money as a result of the lawsuit, the individual whistleblower is entitled to a reward of between 15% and 30% of the amount recovered.
If you have evidence of false claims submitted to Medicare, Medicaid, or other government programs, you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and legal protections as a whistleblower.
To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728.