A former employee of MedStar Health Inc. has filed a whistleblower lawsuit against her employer under the False Claims Act. Court documents allege the company engaged in fraudulent activity together with a vendor, Accretive Health Inc., to boost Medicare inpatient claims at hospitals.
Claims of Medicare Fraud
Medicare pays more to hospitals for patients who are admitted for inpatient care than it does for patients who are on observation status. The plaintiff claims that while working at MedStar Washington Hospital’s emergency department, she helped to submit false claims to Medicaid, Medicare and Tricare. She alleges that Accretive took patients who were on observation status and created written recommendations for them that justified admitting them as inpatients. The Accretive personnel making the recommendations did not have the qualifications or even the information required to do so. The suit alleges that MedStar staff were then pressured into accepting the recommendations.
The lawsuit alleges that Accretive went as far as to claim to hospital administrators at different hospitals around the country that they could provide a revenue lift from Medicare. The suit describes a system designed by Accretive to exploit the administrators’ need for revenue and diminish the authority of the hospitals’ own doctors by overriding them with the fraudulent recommendations.
The False Claims Act
The False Claims Act is a federal law that holds people and companies liable for defrauding the government. It is the government’s primary tool for litigation against fraud. The Act’s qui tam provision enables private citizens to bring suit on behalf of the government. This is commonly known as whistleblowing. Whistleblowers filing under the False Claims Act receive a portion of the money recovered – usually between 15 to 25 percent. Whistleblowers are also entitled to protection against retaliation because they exposed fraud.
Philadelphia Whistleblower Lawyers at Sidkoff, Pincus & Green P.C. Represent Whistleblowers in False Claims Act Cases
Qui tam cases are complex and require thorough knowledge of whistleblower law. The Philadelphia whistleblower lawyers at Sidkoff, Pincus & Green P.C. can review your case if you believe that you have been retaliated against for whistleblowing. Call 215-574-0600 to schedule an appointment in our Philadelphia offices or contact us online. We serve clients throughout Pennsylvania and New Jersey.