Qui Tam

Health System settles Qui tam suit for $1.9 million

By Brian F. LaBovick

Whistleblower Anthony Kite has $1.9 million reasons to be happy this Thanksgiving. The Pennsylvania based, St. Vincent Health System settled a qui tam case pay $1.9 million to the federal government to settle a whistleblower lawsuit that alleged the hospital submitted reimbursement claims to Medicare that greatly exceeded actual costs. 

This is the latest in a string of whistleblower cases settled against hospitals.  What makes this cases really interesting is that the whistleblower, Anthony Kite, has been instrumental in bringing several qui tam cases to light.  According to Mr. Kite, St. Vincent Health System increased Medicare reimbursement claims from 2001 to 2003 with the hopes of receiving what is commonly referred to as "outlier" or supplemental payments.  Surprisingly, other hospitals were doing the same thing according to allegations brought by the whistleblower.

What makes this suit fascinating is that Medicare uses "outlier" payments to hospitals for instances where costs for treating a patient exceed a predetermined reimbursement amount for a particular type of treatment.  One can only imagine how many times hospitals have taken advantage of this loophole to try and take advantage of Medicare billing.

A few other qui tam suits against Hospitals and Health Care Systems include:
Cooper University Hospital in Camden, N. J., $3.85 million settlement.
Warren Hospital in Phillipsburg, N.J., $7.5 million settlement
Bayonne Medical Center in Bayonne, N.J., $2.5 million settlement
Cathedral Healthcare System in Newark, N. J. $5.3 million settlement
Raritan Bay Medical Center in Perth Amboy, N.J. $7.5 million settlement
Grand Total: $26,650,000.00 - In Qui tam/ whistleblower suits against Health Systems

Now, I must caution you to not think that every whistleblower claim produces results like these, because they do not. It takes PROOF and hard FACTS to prove the claim and it takes time.  As most whistleblowers can attest to this fact.

Click here to read more on this whistleblower suit against health systems.

Click here to read more on qui tam statutes and how to file a whistleblower claim.

Full post as published by Whistleblower Law Blog on November 26, 2008 (boomark / email).