The Department of Justice announced one of the largest settlements in the recent history for the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Bringing a resolution to a long and devoted effort to protect taxpayers from rampant Medicare fraud, the settlement resolves claims against more than fifty-five hospitals and total over $34 million dollars. Fifty-one of the claims settled last week were brought under the qui tam, or whistleblower, provisions of the federal False Claims Act for facilities incorrectly charging for kyphoplasty procedures.
Kyphoplasty is a minimally invasive procedure that can be utilized to treat spinal fractures often resulting from osteoporosis.
$5.5 million of the settlement will go to the whistleblowers who brought suit against the hospitals on the government?s behalf. The the federal False Claims Act allows private individuals to bring suit against someone defrauding the government and, if recovery is successful, share in the proceeds of the recovery.
The False Claims Act and the efforts of the HEAT task force work to protect the American taxpayers from fraudulent claims. Medicare fraud is a constant problem and it is often only thanks to the brave efforts of whistleblowers that the fraudulent practices of these facilities are exposed,? commented Christopher Paulos, an attorney with the Levin, Papantonio law firm, who works in the areas of qui tam and whistleblower litigation.
The lawsuits were originally filed in Buffalo, N.Y. by Craig Patrick and Charles Bates. The gentlemen were formerly managers with Kyphon, Inc., in Birmingham, Alabama. Mr. Patrick and Mr. Bates exposed the hospitals’ practice of billing for kyphoplasty procedures as an inpatient procedure rather than outpatient surgery.
Since 2009, the government has recovered over $14.7 billion under the False Claims Act. Allowing individuals to share in the recovery against those defrauding the government encourages individuals to report fraud.
Anyone with information about healthcare fraud should consult a qualified lawyer before blowing the whistle as they may lose their legal standing under the federal False Claims Act to bring suit if the fraud is not properly exposed.
Joshua is a writer and researcher with Ring of Fire.