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Shands Hospital to Pay $26M to Settle Medicare Fraud Case Brought by Whistleblower

Shands Hospitals will pay $26 million to settle a Medicaid/Medicare fraud case accusing it of admitting patients that didn’t require hospitalization to six of its facilities. A whistleblower claim submitted in 2008 claimed that the company overbilled Medicaid and Medicare with the admissions.

The Medicare/Medicaid fraud lawsuit accuses Shands of billing the two programs for short overnight inpatient admissions instead of outpatient services, which are less costly. The $26 million, however, settles just part of the allegations. Claims that the hospitals turned in fraudulent outpatient service bills are still pending.

The person that brought the whistleblower lawsuit, Terry Myers, was as an independent consultant by Shands to audit its health system billing practices several years ago. Shands said that there was system failure and serious insufficient management oversight to abide by Medicaid/Medicare regulations.

Medicare Billing Fraud
When Medicare billing fraud happens, it is the taxpayers that end up paying. Yearly, the cost for this type of fraud is billions of dollars.

One common type of Medicare billing fraud is called upcoding, which involves a medical provider billing for a more costly procedure or diagnosis than what was actually provided. Examples of other types of Medicaid billing fraud include billing for medical services or goods that were not provided, conducting procedures and tests that aren’t needed in order to bill for them, double billing, and unbundling, which involves billing piecemeal for procedures or test that would cost less if billed together as a bundle.

Whistleblower Lawsuits for Medicare Fraud
The Qui Tam provision of the False Claims Act lets privet citizens act as “whistleblower” to expose Medicare billing fraud. Whistleblowers are entitled to a percentage of what is recovered for the US government.

Our Massachusetts Medicare Billing Fraud Attorneys at Altman & Altman LLP handle all kinds of Medicare fraud claims and we also represent whistleblowers, protecting their rights and ensuring that they get the compensation they are owed.

Shands Hospital pays $26 million in fraud settlement case, Orlando Sentinel, August 19, 2013

The False Claims Act (PDF)

Medicare.gov

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