A Washington, D.C., children’s hospital and its affiliates will pay the U.S. nearly $13 million to resolve a whistleblower lawsuit alleging it submitted false cost reports and other information to the government so that it could receive higher reimbursements from the taxpayer-funded health care programs.
The lawsuit, filed against Children’s National Medical Center and its affiliated companies by James Roark Sr., a former employee of the hospital, accused the company of misreporting information on cost reports and applications it submitted to Medicare and Medicaid, which those programs used to calculate reimbursement rates.
The Justice Department said Children’s National Medical Center misreported its number of available beds in applying for federal funds to help it maintain its graduate medical education program for training pediatric residents. The hospital also filed reports that exaggerated its overhead costs, which resulted in overpayments from Medicare and the Virginia and District of Columbia Medicaid programs.
“The false reporting alleged in today’s settlement deprived the Medicare Trust Fund of millions of taxpayers’ dollars,” said Justice Department Assistant Attorney General Benjamin Mizer. “Such conduct wastes critical federal health care program funds and drives up the costs of health care for all of us.”
“We will continue to work with whistleblowers like the former employee who came forward in this case to battle waste, fraud and abuse that fuel the skyrocketing cost of health care,” said U.S. Attorney Vincent Cohen Jr. of the District of Columbia.
Mr. Roark Sr. filed the lawsuit under the qui tam or whistleblower provisions of the False Claims Act, which authorizes private citizens to sue on behalf of the United States and share 15 to 30 percent of any amount the government recovers as a result. The Justice Department said Mr. Roark will receive $1.89 million of the $12.9-million settlement as his share.
Source: U.S. Department of Justice