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Whistleblower Lawsuit Against Christ Hospital Contends $28 Million In Unsubstantiated Claims Submitted To Medicare
Christ Hospital In Cincinnati, OH May Face Up To $90 Million In Fines In Whistleblower Lawsuit Alleging The Hospital Submitted $28 Million In Unsubstantiated Medicare Claims
A federal judge in Cincinnati has rejected Christ Hospital’s request to dismiss a whistleblower lawsuit, Biz Journals reports. The original suit alleged that $28 million in unsubstantiated claims were submitted to Medicare for the training of new doctors who may have also been claimed by other local hospitals. The hospital lawsuit will go to trial if Christ Hospital does not settle the case.
The whistleblower contends that Christ Hospital trained about 25 resident doctors annually, claiming $186,000 in reimbursement per person- equaling about $28 million dollars between 2007 and 2012 while failing to document the training. According to the lawsuit, this is about the same practice as a person claiming a large, undocumented charitable donation on their taxes. The federal False Claims Act allows for triple damages, meaning the hospital could be ordered to pay nearly $90 million if found guilty of false claims. If it proceeds, the case will investigate other hospitals in the area compensated by Medicare to determine if these hospitals also received compensation for resident doctors who trained with Christ. If the case is not settled, other hospitals will be subpoenaed for records review.
The whistleblower lawsuit further alleged that doctors working at Christ hospital for training between 2007 and 2012 also worked as residents of Cincinnati Children’s Hospital Medical Center, Jewish Hospital, the University of Cincinnati Medical Center, and Good Samaritan Hospital. The U.S. District Court for Southern Ohio first filed the suit in December 2013, but the case was sealed until March 2014, at which time Christ Hospital requested it be dismissed. [bizjournals.com/cincinnati/news/2015/01/05/christ-hospital-fights-whistleblower-lawsuit.html?page=all, January 2015]
The woman who filed the whistleblower suit was fired after she discovered the hospital’s Medicare billing violations. She was hired after Christ Hospital entered an agreement with the Office of the Inspector General for the U.S. Department of Health and Human Services to keep track of their expenses, which allowed the hospital to continue receiving funds from federal health care programs like Medicare and Medicaid. The suit was filed on behalf of a former Christ employee who was eventually fired from the hospital. The suit alleges that the hospital did not follow federal law which requires that all reimbursement claims for graduate medical education be documented. The suit alleges that Christ Hospital cannot prove that it was entitled to receive the funds from the government. If a jury decides that Christ Hospital is guilty of filing false claims, the hospital could be liable for up to $90 million in damages not including legal fees.
In 2010, Christ Hospital and the Health Alliance paid a $108 million settlement resolving allegations that the hospital rewarded cardiologists who referred patients to Christ with kickbacks. The hospital would have been ineligible for further federal funding if it had not implemented the new reporting procedures.
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