Renown Health has agreed to pay $9.5 million to settle allegations that it submitted false claims to Medicare for in-patient hospital services. According to a whistleblower complaint, the services should have been billed at much lower rates for out-patient or observation services.
The settlement resolves a qui tam or whistleblower lawsuit brought by a former employee under the False Claims Act. That law allows individuals with evidence of false claims to commence a lawsuit on behalf of the government and share in any recovery.
The whistleblower in this case will receive a $1.7 million reward from the settlement.
During her employment as Director of Clinical Compliance, the whistleblower noticed a number of technical billing discrepancies. One of the issues she noticed was the submission of claims to Medicare for in-patient care when it appeared that the patients had never been admitted to the hospital. After bringing her concerns to management without any success, the whistleblower brought her concerns to the government in the form of a qui tam lawsuit.
Qui tam lawsuits are filed “under seal” (that is, in secret) to allow the government time to investigate before the defendant learns that it is a suspect in a Medicare fraud investigation. The government then decides whether to pursue the lawsuit on its own, or to allow the whistleblower, known as a “relator,” to pursue the lawsuit on its behalf.
If the government pursues the lawsuit and wins, the relator is entitled to a reward of between 15% and 25% of the amount actually recovered. If the relator pursues the lawsuit on behalf of the government, then she is entitled to a reward of between 25% and 30% of the amount recovered plus her attorney’s fees and costs.
If you have evidence of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to legal protections and a significant financial reward. There are, however, strict procedural requirements and time limits to qualify for a whistleblower reward. You should not delay.
To schedule a free and confidential consultation with a whistleblower lawyer, call John Howley, Esq. at (212) 601-2728.
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