Consumer Fraud

U.S., Georgia hospital settle whistleblower Medicare fraud case for $8 million

osha whistle U.S., Georgia hospital settle whistleblower Medicare fraud case for $8 millionA Georgia long-term acute-care hospital and its managing company have agreed to pay the U.S. government $8 million to settle a whistleblower’s allegations that they were involved in a scheme to defraud Medicare between 2003 and 2009.

Darlene Tucker, was a former administrator at Southern Crescent Hospital for Specialty Care, Inc. (Southern Crescent) in Riverdale, Ga., filed a whistleblower complaint under the False Claims Act (FCA), which allows individuals to sue on behalf of the U.S. government when they witness fraud, mismanagement, abuse and other wrongdoing against taxpayer-funded government agencies and programs and share in the recovery.

According to the U.S. Justice Department, Ms. Tucker sued Southern Crescent and its managing company, Dubuis Health System, a Texas-based company that describes itself a “faith based not for profit family of long term acute care hospitals.” Ms. Tucker’s complaint alleged that Southern Crescent and Dubuis “knowingly kept patients hospitalized beyond the time considered to be medically necessary, to increase their Medicare reimbursement and to maintain Southern Crescent’s classification as a long-term acute care facility.”

Long-term acute-care hospitals are similar to typical acute-care hospitals except that they are certified to focus on patients with more complex medical needs who remain in the hospital more than 25 days, on average. Such hospitals receive a higher rate of Medicare reimbursement than do typical acute-care hospitals.

“Billing Medicare for patient care that is not necessary or appropriate contributes to the soaring costs of health care,” said Stuart F. Delery, Acting Assistant Attorney General of the Justice Department’s Civil Division. “This settlement demonstrates the Department of Justice’s commitment to protect public funds and guard against abuse of the Medicare system.”

“Hospitals that violate the public trust by keeping patients hospitalized beyond what is medically necessary will not be tolerated.  Our office will continue to bring cases that enforce our health care laws,” said Kenneth Magidson, United States Attorney for the Southern District of Texas.

The case was jointly handled by the U.S. Attorney’s Office for the Southern District of Texas, the Justice Department’s Civil Division, and the Office of the Inspector General of the Department of Health and Human Services.

Ms. Tucker will receive $2.16 million for her role in exposing the fraud and helping the government recover vital Medicare funds.

Source:

U.S. Department of Justice