Blog

Takeaway

Some combination of Medicare and Medicaid pay for more than half of all long-term care facility and inpatient hospital stays in the U.S. The resolution of a recent whistleblower claim under the False Claims Act points out how submitting accurate and precise claims to these agencies can save clients a great deal of time, aggravation, and money.

The Case

A Chicago health care company and its previous owners will pay nearly $2 million over the course of three years to the United States, the State of Illinois, and the State of Indiana to resolve allegations of submitting false claims to Medicare and Medicaid.

In June, a settlement was announced between an independent nurse practitioner group based in Skokie, Illinois, and the U.S. government. The settlement resolved whistleblower claims brought by a former employee under the qui tam provisions of the False Claims Act. (The False Claims Act provides an avenue for citizens to bring lawsuits on behalf of the U.S. for claims of fraud. Those citizens may then share in any recovery received.)

The former employee alleged in a civil suit that the nurse practitioner group overbilled Medicare and Medicaid for nurse practitioner services in skilled nursing facilities through the use of its own proprietary charting software. Evidently, nurse practitioners charted patient visits using the proprietary software, which then generated false, upcoded claims that were then submitted to Medicare and Medicaid for payment.

The settlement and consent judgment order were announced jointly by the United States Attorney’s Office for the Northern District of Illinois, the Chicago Division of the U.S. Department of Health and Human Services, the Office of Inspector General, and the Chicago Field Office of the FBI.

Details of the agreement are available on the justice.gov website. (Note that this settlement agreement is not an admission of liability on behalf of any party, and all allegations in the civil suit are merely accusations.)