This summer, Eagleville Hospital, a provider of various substance abuse treatments to Medicare and Medicaid patients, agreed to a $2.85 million settlement with the government in the face of allegations it defrauded various healthcare programs. In the lawsuit, it was alleged that the hospital billed Medicare, Medicaid and the Federal Employees Health Benefits Program fraudulently (and repeatedly), resulting in millions of dollars of losses.
The whistleblower who brought forth the False Claims Act lawsuit that led to the settlement received $500,000 for the role they played in the case, in accordance with a stipulation of the False Claims Act that allows whistleblowers to receive between 15 and 30 percent of resulting recoveries in their cases.
According to the original complaint, Eagleville Hospital routinely admitted certain categories of patients that allowed it to get the highest reimbursement category of detox treatments, even if those treatments were not medically necessary for those patients. This misconduct occurred from January 2011 to December 2018.
In addition to paying the monetary settlement, Eagleville also entered into a five-year Corporate Integrity Agreement. As part of that agreement, the hospital will have all of its billing processes to federal programs closely monitored by the Department of Health and Human Services.
If you believe you have knowledge of wrongdoing by your company or agency, it is crucial you provide the information you have to the proper authorities. For more information about how to begin your whistleblower claim, contact an experienced attorney at Kardell Law Group.