Independent Health and one of its subsidiary companies, DxID, were recently sued in a federal whistleblower case. The plaintiff, Tera Ross, is a former medical billing manager at Group health Cooperative in Seattle.
The lawsuit charges the defendants with using false risk adjustment information to maximize their claims amounts from the U.S. government. Ross claims her former employer collected $8 million in Medicare for services in 2010 as a result of the scheme. Group Health Cooperative was a client of DxID.
The lawsuit alleges the defendants validated member diagnoses and coding for claims submitted to the Centers for Medicare and Medicaid Services. Both DxID and Independent Health dispute the claims made in the lawsuit, and already filed motions to dismiss the lawsuit entirely. Statements issued by the company indicate Independent Health’s intent to “vigorously” defend itself in the lawsuit. The company insists all parties were properly paid.
False claims a common type of healthcare fraud
Healthcare fraud accounts for billions of dollars of losses every year from the federal government, and one of the more common types of healthcare fraud is the submission of false claims. Exaggerating symptoms, lying about types of treatment or providing treatments not needed are all examples of common fraud that can fall under this category, as they allow healthcare organizations to submit larger Medicare and Medicaid reimbursements than they would otherwise be entitled to receive.
In many cases, these instances of fraud only get revealed because of insider information provided by whistleblowers who worked for the companies perpetrating those fraudulent schemes. Therefore, if you are aware of wrongdoing within your healthcare organization, it is important to contact an experienced whistleblower lawyer at Kardell Law Group so you can properly report what you know.