A former auditor for Lee Health alleges in a federal whistleblower lawsuit that the Florida hospital system routinely defrauded Medicaid and Medicare by inflating doctor’s bills to drive more referrals to its clinics and hospitals.
The case specifically points to fraudulent incidents involving certain neurosurgeons, cardiologists, pulmonologists and a cancer doctor who received six- and seven-figure salaries based partially on care that was actually provided by physicians’ assistants and nurses. In some cases, the doctors getting paid for those treatments were not even at the hospital at the time. This would violate the federal Stark Law, which prohibits certain types of self-referrals.
Healthcare fraud an expensive problem for the federal government
It is impossible to determine exactly how much the federal government is affected by healthcare fraud every year, but most reasonable estimates are in the billions of dollars. In many cases, evidence of healthcare fraud (or even awareness of the fraudulent schemes) would not be possible without information provided by whistleblowers from within those healthcare organizations.
A person who is aware of wrongdoing within their organization or agency may file a lawsuit on behalf of the federal government under the False Claims Act. The government can then join in the lawsuit later on if it wishes to do so, and the person who initially files the claim may share in any money that results from settlements or enforcement actions.
If you have information about any fraudulent scheme occurring in your business or organization, meet with a dedicated whistleblower attorney at Whistleblower Law for Managers to learn more about your options.