Shands Healthcare to Settle $26 Million Whistleblower Case on Inpatient Billing By Tod Aronovitz | 08/29/13 | 0 Comment

Shands Healthcare, which operates a network of six hospitals in Florida, agreed to resolve allegations that the health care provider submitted false claims to Medicare, Medicaid and other federal health care programs for inpatient procedures that should have been billed as outpatient services. The company will pay the government and the state of Florida a total of $26 million in the settlement, according to the Justice Department.

The lawsuit was originally filed in federal district court in Jacksonville, Fla., in 2008 by independent contractor Terry Myers, the president of healthcare consulting firm, YPRO Corp. Myers, who found Shands’ problematic billing practices in a routine audit, revealed that the hospitals knowingly charged Medicare, Medicaid and TRICARE for short, overnight inpatient admissions rather than less expensive outpatient or observation services for some patients from 2003 through 2008.

“The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire of health care providers to maximize profits,” said Stuart F. Delery, Assistant Attorney General for the Civil Division, in a news release issued by the Justice Department. “Hospitals participating in Medicare must bill for their services accurately and honestly.”

According to Timothy Goldfarb, CEO of Shands Healthcare, the case involved billing practices only, not medical issues. He said that the hospitals started amending their billing practices before the lawsuit was filed, and in the cases of alleged overbilling, all services ordered were provided to patients.

The six Florida hospitals named in the qui tam lawsuit were: Shands at Jacksonville; Shands at Gainesville, also known as Shands at the University of Florida; Shands Alachua General Hospital; Shands at Lakeshore; Shands Starke; and Shands Live Oak.

The case is United States of America and the State of Florida ex rel. Terry L. Myers v. Shands Healthcare et al., Civil Action No. 3:08-cv-441-J-16HTS (M.D. Fla.).

How to Report Miami Medicare Fraud

Healthcare or medical billing employees who have inside knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with Miami whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss a case.