Hospitals may engage in healthcare fraud in a variety of ways, including by overbilling federal healthcare programs and by paying kickbacks to physicians to induce them to refer patients to the hospitals for expensive procedures. Examples of such practices that whistleblowers have exposed include the following:
- In 2021, a Florida hospital paid $22 million to resolve allegations that, among other things, it automatically ordered and billed for certain unnecessary lab tests and that it converted multiple private physician offices to hospital facilities, and then sought payment at higher rates without providing beneficiaries the required notice.
- In 2021, a Massachusetts hospital paid $2.6 million to resolve allegations that it had misused billing code “Modifier 25” to bill Medicare and Medicaid for office visits that were not separate from procedures for which the hospital was already billing;
- In 2020, a West Virginia hospital paid $50 million to resolve allegations that the hospital hired doctors as employees and paid them more than their services were worth in order to capture referrals those doctors made that could be billed to government healthcare programs; and
- In 2018, a Florida hospital chain, Health Management Associates, paid $260 million to resolve criminal and civil charges that it billed government healthcare programs for inpatient services that should have been billed as outpatient or observation services, paid remuneration to physicians in return for patient referrals, and submitted inflated claims for emergency department facility fees.
Whistleblowers who have brought successful False Claims Act qui tam cases against hospitals include patients, physicians, and employees who have worked in hospitals or for health providers that do business with hospitals. If you have information about a hospital that has engaged in fraud or a kickback scheme, please contact us here or at 617-917-2875.