A former Boca Raton Regional Hospital has filed a whistleblower complaint accusing the facility’s administrators of purposely using the wrong billing code to defraud Medicare of at least $2M. This was allegedly an attempt to get more government money for treating patients with heart problems.
For now, the US Justice Department has agreed not to pursue a case against the hospital. Jeannette Lavoie, however, has decided to file a Medicare billing fraud lawsuit under the False Claims Act. If her claims prove founded, the Florida hospital could end up paying three times more than what it overbilled Medicare. The act also allows Lavoie to recover up to 30% of these damages.
Lavoie, who served as the hospital’s case management director, says she grew worried that improper reporting was occurring in regards to what procedure heart patients were getting and as to whether these were occurring on an outpatient or inpatient basis. She said that after she expressed her concerns to administrators, they refused to resubmit their bills. They also assumed auditors wouldn’t discover the errors.
Lavoie claims that Boca Raton Regional Hospital turned in over 600 fraudulent claims between July 2006 and January 2009. Meantime, the hospital is denying her allegations and accusing Lavoie of just being out for money.
False Claims Act
The False Claims Act’s “qui-tam” provision lets US citizens file whistleblower complaints on behalf of the government. Unfortunately, Medicare billing fraud is one way others may try to get more money out of the government. Examples of Massachusetts Medicare fraud includes billing for services or goods not provided, conducting tests that aren’t actually needed, up-coding, billing twice for equipment or services, and unbundling.
Lawsuit alleges Boca hospital defrauded Medicare, Sun-Sentinel, November 14, 2011
What is the false claims act?
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Whistleblower in Bank of New York Mellon Corp. Probe to Receive Reward for Helping the Justice Department, Boston Injury Lawyer Blog, October 13, 2011
Whistleblower Lawsuit Accuses Southern Care of Charging Medicare While Fraudulently Enrolling Patients in Hospice Care, Boston Injury Lawyer Blog, September 27, 2011
Do not hesitate to speak with an experienced Boston injury lawyer to determine whether you may have grounds for a Massachusetts whistleblower fraud case. In addition to serving your government, you may be entitled to a percentage of the recovery.