It will cost $8 million to settle allegations that Dubuis Health System and Southern Crescent Hospital for Specialty Care, Inc. filed false claims for payment to Medicare, the Department of Justice announced last week. According to the allegations of the lawsuit the groups faced, the facilities were taking advantage of individuals needing long-term acute care.
“Individuals needing care for complex and acute ailments are often unaware of how the hospital is billing for the care they are receiving,” commented James Kauffman, an attorney with the Levin, Papantonio law firm who practices in the areas of false claims and whistleblower litigation. “Unfortunately, this lack of awareness can translate into facilities erroneously billing and overcharging the government for services on the patient’s behalf.”
Long-term acute care refers to patients suffering from more complex ailments and staying in facilities more than 25 days.
According to the Department of Justice, the facility knowingly kept patients longer than was medically advisable in order to bill Medicare for those extended stays. The facilities continued this practice from 2003 to 2009. Not only was this practice engaged in to inflate their revenue, but the practice supported the classification of Southern Crescent as a long-term acute care facility.
The behaviors of Dubuis and Southern Crescent were brought to the attention of the Justice Department through the filing of a whistleblower lawsuit under the False Claims Act. Former administrator with Southern Crescent, Darlene Tucker, filed the suit and will be receiving $2.16 million of the government’s recovery.
“The brave actions of whistleblowers like Ms. Tucker are often the only means by which corruption and fraud are exposed,” Mr. Kauffman continued. “Fortunately, the False Claims Act rewards those who have the courage to bring these actions and allows whistleblowers to share in the recovery.”