Baptist Health Systems, one of the largest healthcare providers in San Antonio, agreed to pay $3.67 million to the U.S. Department of Justice to settle whistleblower allegations it filed false claims for Medicare reimbursement.
Norma Rivera, a former employee, alleged in the whistleblower suit that the organization improperly filed Medicare claims by failing to disclose that a patient receiving treatment had another insurance policy that covered the hospital's care, according to the U.S. Attorney's Office Western District of Texas. In addition, the lawsuit claimed Medicare overpaid Baptist Health on claims from 2003-2007.
The hospital system cooperated with the investigation, including conducting an audit of claims dating back to January 2003, according to United States Attorney Robert Pitman. Under the terms of the settlement, Rivera will receive $661,500. In addition to paying $3,675,000, Baptist Health paid Rivera's attorneys' fees and expenses. U.S. Attorney Harold E. Brown, Jr. of the Affirmative Civil Enforcement Unit investigated the case and negotiated the settlement.
Brown told Texas Public Radio that Rivera first reported the problem to her employers in 2004. She later left the hospital but when she returned to work in 2006, she found out they were continuing to bill Medicare incorrectly. This time when Rivera alerted Baptist Health to the problem, she hired a lawyer and filed the lawsuit.
However, Baptist Health claimed Rivera didn't bring the problem to its attention in 2004 and when she pointed it out in 2006, the system immediately implemented corrective action, according to the article.
Meanwhile, in an unrelated case, a Tennessee federal judge this week threw out a whistleblower suit against Ascension Health, the nation's largest Catholic and nonprofit health system, according to Law 360.
The lawsuit alleged that Ascension Health inappropriately billed Medicare for diagnostic work performed by noncertified technicians. But, Law 360 reports that U.S. District Judge Todd J. Campbell said whistleblower Stephen McMullen didn't identify a single specific false claim submitted to Medicare by one of the three Ascension hospitals listed in the lawsuit.
Whistleblowers are becoming an increasingly powerful weapon against healthcare fraud, as states look to qui tam settlements to pad their tight budgets, FierceHealthcare previously reported.