Recently, Health Management Associates (HMA), a subsidiary of Community Health Systems, Inc. (CHS), resolved charges that they defrauded the federal government, and will have to pay over $260 million. The government alleged that HMA knowingly billed Medicare and Medicaid for inpatient services that should have been billed as outpatient or observation services. Additionally, they were charged with submitting inflated claims for emergency department fees. To read about the latest settlement, click here for the Department of Justice’s press release.
This is not CHS’ first time to the rodeo. Our law firm previously represented a doctor and two nurses in a case with CHS, U.S. v Community Health Services, Inc.. CHS agreed to pay $98.15 million to resolve those claims which mirror the more recent HMA settlement. Our case was filed on behalf of our two whistleblower clients in the federal court in Nashville, Tennessee. Click here to read more about our case.
When a patient arrives at a hospital, they are designated as inpatient, observation or outpatient status. The status matters because they affect Medicare and Medicaid’s reimbursement rates. Medicare and Medicaid will cover the costs of inpatient care after a three-day hospital stay, but will not cover the costs of observation or outpatient care. According to the qui tam we filed, CHS deliberately admitted and billed patients as inpatient status, even though their status should have been outpatient, in order to receive Medicare reimbursement rates.
Since January 2009, the federal government has recovered $19.3 billion from health care fraud actions alone. The qui tam provision of the False Claims Act allows ordinary citizens to help the government stop fraudulent activity.
To learn more about our Whistleblower & Qui Tam practice click here. Our firm is located in Nashville, Tennessee, but we represent whistleblowers all around the country. Call us today at (615) 244-2202.