A Florida-based hospital chain and affiliated companies filed a motion in federal court Monday seeking to have a whistleblower’s claims against them thrown out. The companies say that the complaint alleges they improperly billed Medicare and Medicaid for services, but fails to link those allegations to any actual submission of false claims to government-subsidized health care programs.
According to Law 360, Brenda Farnsworth’s lawsuit includes allegations that Hospital Corp. of America Inc., Parallon Business Solutions LLC, and Galencare Inc., which operates under the name Northside Hospital, “falsified records to dupe Medicare and Medicaid into covering unsafe – sometimes fatal – procedures that were ineligible for reimbursement because they violated federal rules.”
Those procedures, she alleges, were performed by unsupervised medical interns and resident physicians, disputing the hospital’s claim that the procedures were indeed supervised by resident physicians. Ms. Farnsworth says that those and other procedures amounted to the submission of false claims in an effort to extract payments from federal health care programs.
The U.S. False Claims Act (FCA) contains “qui tam” or whistleblower provisions that give private individuals the power to sue on behalf of the U.S. government when they have witnessed fraud and other wrongdoing. In exchange, whistleblowers suing under the federal act can receive up to 30 percent of the recovery. The FCA’s whistleblower provisions are some of the U.S. Justice Department’s most effective tools in fighting fraud that hurts U.S. taxpayers.
The defendants named in Ms. Farnsworth’s lawsuit strongly dispute her allegations. In their motion to have the case tossed, they say the plaintiff “divides her grievances into five categories, attaches labels of fraudulent conduct to each, and then proceeds to identify dates, physicians, procedures and patients associated with alleged misconduct. But nowhere does she allege the actual submission of a false claim to the government.”
The defendants also assert that Ms. Farnsworth’s claims of retaliation are invalid because her position as vice president of quality and risk management was a watchdog role within the company, requiring her to routinely investigate and report misconduct at Northside Hospital.