The legal journey began when two emergency room doctors became aware of a scheme by a major hospital chain and a pair of physicians groups to defraud taxpayers of millions of dollars. Though it is never easy to buck the system, the two doctors listened to their consciences and filed a whistleblower lawsuit against the physicians groups.
The odyssey ended a few days ago when the groups agreed to pay more than $33 million to the federal government and state of North Carolina. The two whistleblowers will share more than $6 million from the settlement.
Under terms of the agreement, a Texas doctors group will pay nearly $30 million and a Pennsylvania physicians group will write a check for $4 million to settle the claims of Medicare and Medicaid fraud.
Prosecutors said the Texas doctors took kickbacks from a now-shuttered chain of acute-care hospitals known as Health Management Associates. In return, the doctors would recommend that their patients get inpatient treatment at HMA hospitals rather than less-expensive outpatient care.
Admitted patients were then subjected by hospital staff to unneeded, expensive tests that boosted Medicare and Medicaid reimbursements to the facility.
According to an article on the scam, Medicare pays, on average, at least three times more for inpatient care than outpatient care.
The two ER doctors who filed the whistleblower lawsuit will split more than $6.2 million from the settlement, the Department of Justice said.
If you know of fraud against the federal government and American taxpayers, you can discuss a False Claims Act lawsuit with an attorney experienced in protecting clients while holding swindlers accountable.