Articles Tagged with hospital fraud

IMG_0209-300x200A whistleblower in Oklahoma, Jennifferr Baird, filed a complaint against the hospital she worked at as a registered nurse for fraudulent Medicaid billing practices. Following the filing, Oklahoma Heart Hospital agreed to settle the allegations with a $2.8 million fee.

Baird was in charge of a team of seven staff members and alleged that for at least seven years the hospital consistently billed Medicaid at inpatient rates, even if the patient was being treated as an outpatient.

“First, OHH routes almost all of its Medicaid patients to inpatient treatment, when many should be classified as outpatient; in doing so OHH is able to charge significantly larger fees for the same treatment. The fraud is evidenced by the fact that OHH does not treat its Medicare or privately insured patients similarly.”, the lawsuit stated.

The Brattleboro Memorial Hospital will $1,655,000 to the United States and the state of Vermont  to settle claims that it “knowingly”  presented “false claims for payment to Medicare and Medicaid.” The U.S. Attorney’s Office alleged that between January 2012 through September 2014, “BMH knowingly submitted or caused to be submitted a number of outpatient laboratory claims lacking documentation necessary to support reimbursement by Medicare and Medicaid.” According to a press release, a whistleblower Amy Beth Main filed a complaint against the hospital under the federal False Claims Act. Qui tam lawsuits are a type of whistleblower lawsuit that rewards whistleblowers in successful cases where the government recovers funds lost to fraud. According to Norman Watts, of Watts Law Firm, in Woodstock, Main will receive between 15 and 20 percent of the settlement, from which he will recover his attorney fees. Ms. Main worked for the hospital in an administrative role in the financial services department.

The case was investigated by the United States Attorney’s Office for the District of Vermont, with assistance from the Office of the Inspector General of the Department of Health and Human Services, and by the Medicaid Fraud and Residential Abuse Unit of the Vermont Attorney General’s Office.