Healthcare Compliance Perspective:
Compliance Officers must emphasize with management to refrain from retaliation and/or intimidation if and when employees present information about potentially fraudulent activities. A failure to accomplish this can result in a whistleblower lawsuit involving separate claims for both the alleged fraudulent activity and retaliation.
Just before the trial was set to begin in the U.S. District Court of the Western District of Pennsylvania last week, a settlement of $20.7 million was reached in a whistleblower lawsuit between the U.S. government and two defendants-an Erie hospital and a heart specialists’ practice. The lawsuit alleged that the hospital paid the heart specialists’ practice to refer patients to the hospital in violation of federal law.
A cardiologist filed a whistleblower lawsuit against the hospital in 2010, one year before the hospital was purchased by a Pittsburgh-based healthcare system.
The settlement will be used to make up for a part of the approximated $50 million loss by Medicare in the alleged fraud for unnecessary cardiac procedures.
In order to counteract the growing competition for patients from another area hospital, it is alleged that the Erie hospital created bogus board of director positions for some of the physicians from the heart specialists’ practice. Millions of dollars are alleged to have been paid to these physicians for patient referrals to the Erie hospital that involved payments from Medicare for a range of heart procedures-some of them unnecessary.
