In a recent settlement with the U.S. government, Baptist Health Systems, Inc. agreed to pay $2.5 million to quell the allegations that some of its subsidiaries were violating the False Claims Act. Baptist is the parent company for a large group of medical providers and hospitals in and around Jacksonville, Fl. The suit alleged that subsidiaries of Baptist were submitting claims to various federal healthcare programs for drugs and services that were unnecessary for patients. The health programs involved include Medicare, Medicaid, the Federal Employee Health Benefits Program, and Tricare.
Many might not realize just how much potential damage it can cause to charge for medical services, treatments, and drugs that are not necessary. However, the fraudulent billing can be damaging in several different ways. First, it contributes significantly to the rising cost of healthcare and drugs on the market. Second, since the government programs are paying out to these companies, it has the potential to cause taxes to rise as well.
The Assistant Attorney General for the Justice Department’s Civil Division agrees with this and says that, “Providers must deal fairly and honestly with federal health care programs, and the Justice Department will investigate aggressively and hold accountable those who do not.” They need to be brought to justice for their unfair practices, and that is just what is happening more and more.
The allegations in this case concern two neurologists who were working in the Baptist Health network who misdiagnosed patients with a variety of different disorders. These disorders, which the patients did not actually have, meant that the network would be billing the government programs for the cost of the services. This occurred from September of 2009 to October of 2011. None of the misdiagnoses were brought to the attention of the government until September of 2012.
The government did not start investigating until a whistleblower filed a lawsuit under the False Claims Act under the qui tam provisions. The whistleblower, Vercheta Wells, once worked for Baptist Health. Under the provisions of the act, people are able to file suits for false claims on the government’s behalf. They receive a portion of the damages for their service as well. In this case, Wells will receive $424,155.
Patrick E. McFarland, the Inspector General of the U.S. Office of Personnel Management said that, ““These health care providers did not only violate the laws of the United States – they violated the trust placed in them by their patients. Federal employees deserve health care providers, including hospitals that meet the highest standards of ethical and professional behavior. Today’s settlement reminds all providers that they must observe those standards and reflects the commitment of federal law enforcement organizations to pursue improper and illegal conduct that may put the health and well-being of their patients at risk.”
The government is very serious about pursuing these types of cases and healthcare fraud, and this is just the latest in a line of similar cases to have come from the Health Care Fraud Prevention and Enforcement Action Team. Thus far, they’ve recovered more than $19.1 billion, and there are still plenty of other investigations underway.