Baptist Health Systems (“Baptist”) has agreed to pay $3.67 million to settle a qui tam lawsuit by a whistleblower who claimed it had submitted false claims to Medicare in violation of the federal False Claims Act. Baptist is headquartered in San Antonio, Texas and includes 5 hospitals: Baptist Medical Center, Mission Trail Baptist Hospital, North Central Baptist Hospital, Northeast Baptist Hospital, and St. Luke’s Baptist Hospital. On Oct. 1, 2013, Baptist Health System and its parent company were acquired by Tenet Healthcare Corporation.
The Department of Justice announced that a former Baptist employee, Norma Rivera, filed a whistleblower lawsuit in the United States District Court, Western District of Texas. The whistleblower claimed that Baptist submitted false claims to the federal Medicare program when it failed to disclose to Medicare that some of the Medicare beneficiaries also had private health insurance. If a patient is dual insured by Medicare and a private insurer, the bill for healthcare services is supposed to be first processed by the private insurance company and then Medicare will pay whatever is not paid by the private insurer, such as the deductible or co-payment. In addition, if the healthcare provider receives a payment from the private insurer after the invoice had already been paid by Medicare, the healthcare provider must reimburse Medicare.
According to the whistleblower, from 2003 to 2007, in addition to not disclosing private insurance, Baptist did not reimburse Medicare for the overpayments it received from the federal public health insurance program.
Baptist has agreed to pay the federal government $3.67 million to settle the whistleblower’s False Claims Act allegations. The federal False Claims Act was enacted at the time of Abraham Lincoln to combat fraud committed by companies that sold supplies to the Union Army during the Civil War. The qui tam provisions of the False Claims Act allows private individuals – called relators – to file suit on behalf of the government in claims alleging the government was defrauded. The whistleblower will receive $661,500 of the settlement proceeds as her reward under the qui tam provisions of the False Claims Act. In addition, Baptist has agreed to pay the whistleblower’s attorney’s fees.
For additional information on how to initiate a qui tam lawsuit, click here.