whistleblower

After Medicaid reimbursement allegations, LA hospital agrees to $3.3M settlement

Dan Bowman — Mon, 20 Oct 2008 12:57:36 -0400

After allegedly collecting Medicaid reimbursement as a Level 1 pediatric-intensive care provider, despite not qualifying for such a status, Marrero, LA's West Jefferson Medical Center will now pay the federal government and the state of Louisiana $3.3 million. According to a lawyer representing the 307-bed public hospital, West Jefferson agreed to the amount because "it could ill afford to challenge the allegations in the extremely difficult financial environment that providers face in the New Orleans area after Hurricane Katrina."

According to Modern Healthcare, the settlement agreement states that the alleged overpayments were made from 1998 to 2003. Peter Butler Jr., an attorney for the hospital, added that the agreement means West Jefferson is "without any concession or admission of liability." An ex-nurse who filed the whistleblower lawsuit under the False Claims Act is supposed to receive $627,000 of the $3.3 million.

For more information:
- read this Modern Healthcare article

Healthcare whistleblowers helped get back $9.3B

Anne Zieger — Tue, 02 Sep 2008 11:52:19 -0400

Whistleblowers have helped authorities recover at least $9.3 billion from healthcare providers according to a new analysis of U.S. Department of Justice records. Since the DoJ began working harder to involve insiders in its efforts to fight healthcare fraud, the number of whistleblowers coming forward has increased. Today, whistleblowers initiate more than 90 percent of the DoJ's lawsuits focused on healthcare fraud.

While they may be moved by unhappiness with what they've seen, the fact that they get between 15 and 25 percent of the amount recovered can't hurt either. Of the $9.3 billion recovered between 1996 and 2005, whistleblowers received more than $1 billion, according to analysts writing for the Annals of Internal Medicine.

As large as these numbers are, they're conservative, as information was available only for about three-quarters of the 379 cases reviewed. Also, some of the most spectacular recoveries took place after the review period. For example, the $920 million settlement with Tenet Healthcare took place in 2006. Also, in recent times, there have been large recoveries from pharmas, pushing average settlements from $10 million per case in 2002 to $50 million in 2005 alone.

To learn more about this research:
- read this Associated Press article

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Amerigroup to pay $225M in Medicaid fraud settlement

Sterling Meyers — Thu, 24 Jul 2008 09:48:43 -0400

Amerigroup, the Illinois health plan that refused to enroll high-risk patients in its Medicaid plan, announced that it will pay $225 million to the state of Illinois and the U.S. government to settle False Claims Act allegations. Though the agreement hasn't been signed by both parties, Amerigroup will pay an additional $9 million in legal fees, and will admit no wrongdoing, according to a press release from the company. Amerigroup Corp., based in Virginia, has also agreed to enter into a Corporate Integrity Agreement with the Office of the Inspector General of the U.S. DHHS. The company's second quarter losses add up to $162.5 million--Amerigroup would have netted $36.7 million without the settlement.

In 2006, the company was ordered to pay $144 million in damages to Illinois and the federal government. Later, a federal judge added another $190 million in civil fines against the company, which was found to have filed more than 18,000 false Medicaid claims. Originally, Amerigroup appealed the verdict, but later it entered into settlement talks with the plaintiffs.

Charges against Amerigroup were originally filed in 2002 by Cleveland Tyson, former vice president of government relations at the plan's Illinois subsidiary. His lawsuit then prompted an investigation by the state attorney general and the U.S. Attorney in Chicago, who later joined the whistle-blower suit. As the original whistleblower, Tyson could see a payout of 15 to 25 percent of the total judgment.

To learn more about the case:
- read this Modern Healthcare article (reg. req.)
- read this Chicago Tribune piece

Related Articles:
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