A former employee of the Spartanburg Regional Healthcare System (SRHS) has filed a whistleblower suit, alleging that SRHS engaged in fraud against the government by filing false claims with Medicare, Medicaid, and TRICARE. The whistleblower claims that, since 2009, the organization’s revenues have been boosted by “hundreds of millions of dollars.” Supposedly, even if the physicians group operated at a loss, SRHS would have come out ahead because more referrals meant much more revenue.
The suit asserts that both the Stark Law and the False Claims Act (FCA) were violated because SRHS deliberately overpaid doctors at its own physicians group, Medical Group of the Carolinas, in order to have patients referred to SRHS. The Stark Law, which by statute applies only to Medicare, requires all compensation to be linked to fair market value, so the overpayment of the doctors broke the law. The law also forbids physician self-referral. What this means is that a physician is not allowed to refer a patient to a “designated health services” organization if the physician, or an immediate member of his or her family, has a financial relationship with the organization.
Because the referrals were allegedly fraudulent and essentially amounted to a kickback scheme, the False Claims Act also came into play. The claims that SRHS submitted to the government for health care expenses—for Medicare, Medicaid, and TRICARE—were therefore fraudulent under the FCA.
Also alleged is the claim that a nurse practitioner in Rutherfordton, NC, added medical codes to patients’ charts for procedures that were never done, meaning that false claims were submitted for nonexistent services.
The whistleblowing employee, Elisabeth Markley, began working for SRHS in 2013 as a physician compensation coordinator, meaning that she managed the pay and benefits that the doctors received. Let go in 2015, she alleges that her termination was the result of retaliation by SRHS. Markley’s qui tam suit was filed under seal (kept confidential while the government investigates) in September, 2015.
This case is not Spartanburg Regional Healthcare System’s first alleged violation of the FCA. In a suit settled in December, 2015, SRHS agreed to pay $1.725 million for their part in a larger scheme involving 32 hospitals in 15 states over mischarging Medicare for kyphoplasty procedures. Kyphoplasty is used to treat certain kinds of spinal fractures that are frequently due to osteoporosis. From all the settlements in this $28 million Department of Justice case, the whistleblowers were to receive $4.75 million.
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If you think you have the facts needed to bring a whistleblower case, the experienced whistleblower attorneys at the Louthian Law Firm can review your case and help you file the appropriate disclosure statement. Under some circumstances, the government will intervene, or join in your lawsuit.
Your chances of succeeding are greater if your whistleblower claim is substantive, clear, and to the point. Because of this, meeting with a qualified whistleblower attorney can increase your chances of winning. The Louthian Law Firm can help you form your claim so that the government will be more inclined to intervene in your case; government intervention can sometimes increase the chances of recovering reward money. Even if the government decides not to intervene, it could still be a good idea to pursue your case without government involvement. Our strong support system can assist you through every step of the process.
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