The Department of Justice announced that it settled part and continues to intervene in the Saint Joseph Health Qui Tam whistleblower lawsuit.
The Saint Joseph Health System, Inc has agreed to pay the U.S. Government $16.5 million to resolve civil allegations that it submitted false or fraudulent claims to the Medicare and Kentucky Medicaid programs for a variety of medically unnecessary heart procedures.
The lawsuit alleged and settlement state –
- three Lexington cardiologists pursuant to the qui tam provisions of the False Claims Act
- That law allows the whistleblowers, also known as relators, to share in settlement proceeds that result from their bringing claims of fraud to the government’s attention
- that between January 1, 2008 until August 31, 2011, several doctors working at the hospital performed numerous invasive cardiac procedures on Medicare and Medicaid patients who did not need them
- The hospital then billed the federal programs for these unnecessary procedures, which include coronary stents, pacemakers, coronary artery bypass graft surgeries (“CABGS”), and diagnostic catheterizations
- The claims seeking reimbursement allegedly violated the False Claims Act because under federal law, Medicare and Medicaid programs only reimburse health care providers for operations that are deemed medically necessary
- Hospitals generally receive between $10,000 and $15,000 for medical procedures such as heart stents
- In this case, Doctors Michael Jones, Paula Hollingsworth, and Michael Rukavina will receive $2,458,810 of the $16.5 million settlement
The Saint Joseph Health qui tam whistleblower lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to receive a share of any recovery. The False Claims Act also permits the government to intervene in such lawsuits, as it has done in this case.
For more information on Qui Tam Whistleblower lawsuits, click here.
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