Ineligible Medicare In-Patient Admissions
Settlement Resolves Allegations
Case Initiated By Former Employee
In fiscal year 2020, the U.S. Department of Justice (DOJ) recovered $1.8 billion in FCA qui tam settlements and judgments involving the health care industry. Private whistleblower suits (known as qui tam cases) under the False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., recovered most of this money in suits against the defrauding healthcare providers which include pharmaceutical companies, medical device makers, clinics, labs, hospitals, nursing homes, therapy providers, and physician groups. Private parties bringing these qui tam suits are referred to as “relators” commonly known as whistleblowers. Whistleblowers recover anywhere from 15% to 30% of the damages and penalties or settlement once the government recovers. 31 U.S.C. § 3730(d). If you have credible information of fraud against the government in Los Angeles, Orange County or elsewhere in California, call us today at (415)441-8669 and we can help. Our toll-free number is 1-888-50EVANS (888-503-8267).
The DOJ recently announced a settlement with a county medical center of False Claims Act allegations brought against the Center in a qui tam case. In the reported settlement, the Center agreed to pay approximately $11.4 million to resolve alleged violations of submitting or causing the submission of claims to Medicare for non-covered inpatient admissions. Medicare reimburses only services that are reasonable and necessary for the diagnosis or treatment of illness or injury. The government alleged that for a period of years the Center admitted certain patients for whom inpatient care was not medically reasonable or necessary, including patients who were admitted for reasons other than medical status, such as social reasons and lack of available alternative placements. The Center allegedly billed Medicare for such patients despite allegedly knowing that the costs for admitting them were not reimbursable by Medicare. “Billing for non-covered hospital stays results in a misuse of federal dollars,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “Today’s settlement demonstrates our continuing commitment to ensure that Medicare pays only for services that are eligible for reimbursement.”
Fighting Against Employer Retaliation
The reported case was brought by a former employee of the defendant medical center. The False Claims Act protects employees against retaliation from their employers for blowing the whistle on fraud against the government. 31 U.S.C. § 3730 (h). Despite the legal prohibition employers continue to retaliate against whistleblowers. The law, however, allows employee whistleblowers to fight back. 31 U.S.C. § 3730(h). If you are fired because you brought any fraud to light, you may be entitled to sue your employer in court and seek double back pay (with interest), reinstatement, reasonable attorneys’ fees, and reimbursement for certain costs in connection with the litigation. 31 U.S.C. § 3730(h)(2). Evans Law Firm, Inc. can represent you in any action for retaliation as well as represent you in your underlying whistleblower application.
If you have credible information of fraud against Medicare or Medi-Cal in Los Angeles, Orange County or elsewhere in California, call Ingrid M. Evans at (415) 441-8669, or toll-free at 1-888-50EVANS (888-503-8267) or by email at <a href=”mailto:firstname.lastname@example.org”>email@example.com</a>. In addition to FCA whistleblower cases, Ingrid also handles bank fraud whistleblower cases under FIRREA/FIAFEA, commodity trading and securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, and tax fraud under the Internal Revenue Service Whistleblower Program.
 Evans Law Firm, Inc. was not involved in the case in any way. The qui tam case is captioned United States ex rel. Levy v. San Mateo County and the San Mateo County Medical Center, Case No. 16-CV-5881 (N.D. Cal.).