A South Carolina hospital will settle claims alleged by a whistleblower for $7 million, according to the US Attorney’s Office.
The whistleblower lawsuit alleged that AnMed Health submitted false Medicare claims in several different scenarios leading to higher reimbursement rates from the government. The lawsuit alleged the hospital would submit bills for radiation oncology services when the practitioner was not participating, billed a minor care clinic as Emergency Services, and submitted bills to the Emergency Department for services not performed by a physician.
A former AnMed employee initiated the whistleblower lawsuit under the federal False Claims Act. The whistleblower will receive $1,202,500 for the lawsuit and an additional settlement of $850,136.50 from AnMed for her wrongful termination claims.
AnMed says that a 2013 investigation into their billing practiced revealed that they fell short of federal regulatory standards. In a statement following the investigation, AnMed noted:
“The very complicated and frequently changing rules and regulations governing how we bill Medicare create inherent difficulties in maintaining constant compliance. These regulatory efforts lead to frequent challenges for health care systems and other providers across the nation. We discovered through an investigation started in 2013 that some of our billing practices fell short of our regulatory obligations.”
Under the terms of the false Medicare claims settlement, AnMed will also enter into a five-year corporate integrity agreement to ensure continuing compliance.
“We are glad to report that the billing errors were largely technical and did not compromise the quality of the care delivered at AnMed Health. We also were pleased that neither our review, nor that of the OIG, revealed any intentional misconduct or criminal wrongdoing,” stated the hospital.
AnMed also noted that it removed a vendor who provided billing and coding services and has increased compliance and audit functions to prevent future errors.
“This is another example of how the False Claims Act whistleblower provisions help protect the public’s interest,” said U. S. Attorney John Horn. “It also reflects our ongoing commitment to safeguard our federal health care programs and the vital care that they provide.”
“Our goal in pursuing Medicare fraud is not only to protect taxpayers, but also to ensure that Medicare beneficiaries receive the quality care they deserve,” stated the Civil Chief for the U.S. Attorney’s Office for the District of South Carolina.
Reporting False Medicare Claims
As noted by government representatives, reporting false Medicare claims is important to protect both taxpayers and ensure Medicare recipients are receiving the quality of care they deserve.
False Medicare claims include fraudulent billing statements that result in overpayment by the government for services not rendered. Employers have an obligation to ensure that their billing practices meet regulatory obligations if they accept federal government funding.
Employees who have evidence that their employer is submitting false Medicare claims should know that they are entitled to protection under the False Claims Act. Employees who go on to file successful lawsuits against their employer for false Medicare claims are also entitled to anywhere between 15 and 30 percent of any damages or settlement awards.
If you have evidence that your employer is submitting false Medicare claims to the government, please consider becoming a whistleblower on behalf taxpayers and Medicare patients. The whistleblower attorneys at Bradley/Grombacher will be happy to guide you through the process. You can obtain a free and confidential review of your claims by filling out the form on this page.