Jacksonville-area hospital Baptist Health, through its parent company, has agreed to pay $2.5 million to settle a whistleblower lawsuit alleging healthcare fraud. The hospital is accused of having unlawfully exploited Medicare and Medicaid funds by billing the government for services not rendered or for services rendered that were not medically necessary.
The case began in 2012 when the hospital’s former referral coordinator began to notice discrepancies in the billing procedures. As a result of her willingness to come forward and report fraud, she will collect approximately $425,000 as her qui tam reward under the False Claims Act.
Details of United States ex rel. Wells v. Baptist Health System Inc. et al.
The case against Baptist Health involves startling allegations of fraudulent diagnoses for purposes of increasing profits at the expense of Medicare and Medicaid. Specifically, the lawsuit alleges that two neurologists on staff at Baptist Health routinely engaged in the practice of wrongfully diagnosing patients with serious neurological and brain disorders. The doctors are believed to have fraudulently diagnosed patients with conditions like multiple sclerosis in order to bill the government for the costs to treat this illness. The patients were unaware that they did not actually have a neurological condition and were required to endure treatment nonetheless.
This practice occurred for a period of approximately two years from 2009 through 2011. The hospital allegedly placed one of the neurologists involved on administrative leave in 2011, but did not reveal the misdiagnoses until about one year later.
The settlement with Baptist Health occurred due to a joint investigative effort between the federal government and the state of Florida. Since the fraud involves state Medicaid funds, Florida will recover close to $20,000 from the settlement amount.
The Inspector General’s Office released the following statement in conjunction with the Department of Justice’s press release on the matter:
“These health care providers did not only violate the laws of the United States – they violated the trust placed in them by their patients… Federal employees deserve health care providers, including hospitals, that meet the highest standards of ethical and professional behavior. Today’s settlement reminds all providers that they must observe those standards and reflects the commitment of federal law enforcement organizations to pursue improper and illegal conduct that may put the health and well-being of their patients at risk.”
The U.S. Attorney’s Office for the Middle District of Florida reiterated the position by stating:
“This settlement sends a clear message that health care fraud will not be tolerated in our district, particularly when there is the potential for harm to patients….”
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