Whistleblower to receive $2 million from hospital settlement over false Medicare claims

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by Jay Pate

The U.S. Justice Department has announced that Dubuis Health System and Southern Crescent Hospital for Specialty Care, Inc. have agreed to pay the United States $8,000,000 to settle allegations that they submitted false claims to Medicare, the Justice Department announced today. Dubuis Health System manages long-term acute care hospitals in multiple states, including Southern Crescent. Southern Crescent is a long-term acute care hospital located in Riverdale, GA and is part of the CHRISTUS Health System.

Long term acute care hospitals are similar to typical acute care hospitals except that they are certified to focus on patients with more complex medical needs who, on average, remain in the hospital more than 25 days. Long term acute care hospitals receive a higher rate of Medicare reimbursement than do typical acute care hospitals. The settlement resolves allegations that between 2003 and 2009, Dubuis Health System and Southern Crescent knowingly kept patients hospitalized beyond the time considered to be medically necessary in order to increase their Medicare reimbursement and to maintain Southern Crescent’s classification as a long-term acute care facility.

The case was initiated by the filing of a whistleblower complaint under the False Claims Act. Under the FCA, private citizens can bring suit for false claims on behalf of the United States and receive a share of the recovery obtained by the Government. The whistleblower in this matter, Darlene Tucker, was a former administrator at Southern Crescent. As a result of this settlement, Ms. Tucker will receive $2,160,000 of the United States’ recovery.

Anyone who has information that a business or person has knowingly submitted or caused the submission of false or fraudulent claims to any branch of the United States government can potentially help file and pursue a lawsuit under the False Claims Act. The “whistleblower” (called a “relator”) does not have to have been personally harmed at all. The relator just needs to be aware of the false or fraudulent conduct.

Many states have similar laws to the federal False Claims Act. The state laws are used when the false or fraudulent claim has been submitted to a state government.

A False Claims Act lawsuit seeks to recover money for the government from the business or person who submitted false or fraudulent claims. If money is recovered—whether from a settlement between the parties or a court judgment—the whisteblower who helped initiate the lawsuit can potentially recover 15 to 30% of the total amount recovered. The whistleblower/relator is rewarded to compensate them and their attorney for the hard work involved in pursuing such lawsuits and also to encourage others to come forward with information about false or fraudulent conduct.

The government has recovered billions as a result of False Claims Act lawsuits, and hundreds of millions have been paid to the private citizens–the relators/whistleblowers—who made the lawsuits possible.

The government has recovered billions as a result of False Claims Act lawsuits, and hundreds of millions have been paid to the private whistleblowers that made the lawsuits possible. If you have questions about how to pursue a claim under the False Claims Act, please let us know. You can reach us by calling our toll-free hotline at 1-877-446-9001, or by filling out our free legal consultation form on this page.