The government has announced a $250 million settlement in whistleblower lawsuits brought against hospitals for submitting false claims to Medicare for cardiac devices implanted in patients.
The whistleblower lawsuits were brought by a cardiac nurse and healthcare reimbursement consultant. As a result of the settlement, they will share a $38 million whistleblower reward under the qui tam or whistleblower provisions of the False Claims Act.
The whistleblowers claimed that the hospitals improperly billed Medicare for implantable cardioverter defibrillators or ICDs. These devices monitor the heart for abnormal rhythms and deliver a shock to restore the heart's normal rhythm. They are similar to external defibrillators, only they are implanted in the patient.
Medicare pays for ICD surgery only if the patient meets certain criteria. For example, Medicare regulations provide that ICDs should not be implanted in patients until 40 days after a heart attack or 90 days after heart bypass surgery or angioplasty.
The whistleblowers in this case claimed that the hospitals were violating the waiting periods, thereby obtaining reimbursement in violation of Medicare regulations and potentially creating health risks for patients.
The whistleblowers filed their False Claims Act lawsuits "under seal" (in secret) and provided their evidence to the government. After conducting an investigation, the government decided to pursue the case and negotiated a settlement with the hospitals.
Under the False Claims Act, the whistlebowers were therefore entitled to a percentage of the government's settlement as a reward. In this case, the whistleblower reward was $38 million.
If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and protections as a whistleblower.
To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728.