In August, Community Health Systems, Inc. (CHS) and Community Health Systems Professional Services Corporation along with 119 of their hospitals settled seven False Claims Act lawsuits for $98 million. Whistleblowers from all around the country came forth with information regarding the inappropriate practices of CHS and its associated entities. The allegations against CHS had to do with inappropriate billing of inpatient services/procedures that they should have billed as outpatient services/procedures, submitting claims to Medicare based on inappropriate referrals from a medical director, and by overcharging for services provided to 65-years or older patients in order to receive great reimbursement amounts.
Not only does CHS have to pay $98 million, but they will be closely monitored by the US Department of Health and Human Services, Office of Inspector General for five years to ensure they comply with the settlement terms according to a corporate integrity agreement. However, the staggering amount and corporate integrity agreement are not the only consequences that came out of this settlement.
This settlement against CHS showed that misconduct and corruption can and will occur on all levels in any corporate structure, and amongst many entities. Here, CHS, 119 CHS-operated hospitals, and the Community Health Systems Professional Services Corporation, which is a subsidiary of CHS were all involved. In addition, this settlement shows that the policies governing whether certain services should be billed as inpatient or outpatient needs serious consideration and re-examination in order to more clearly define which is which.
Perhaps more importantly from the whistleblower side of things, this settlement also shows that anyone can be a whistleblower. In this particular case, the whistleblowers included nurses, physicians, administrative personnel, as well as a Director of Health Information Management. Because these whistleblowers came forth with information regarding the inappropriate practices of CHS and its associated entities, they have successfully been stopped from inappropriate billing practices. Furthermore, the numerous whistleblowers that brought same or similar claims against the same CHS entities for similar misconduct convinced the US Department of Justice to intervene in the lawsuit.
Whistleblowers are necessary to unearth inappropriate practices within corporate entities. If not for them, many corporations will continue to defraud the government and the people of money.
The Evans Law Firm, Inc. handles qui tam (false claims/whistleblower) actions, securities fraud whistleblower award lawsuits, IRS tax fraud lawsuits, and employment and retaliation litigation. If you think or you have a whistleblower claim, contact the Evans Law Firm for a free and confidential consultation at 415-441-8669 or email firstname.lastname@example.org