South Miami Hospital has agreed to a settlement amount of $12 million in a Medicare fraud whistleblower lawsuit over unnecessary surgeries.

The Medicare fraud whistleblower lawsuit alleged that a heart specialist at South Miami Hospital made a habit of performing cardiac procedures that were both medically unnecessary and costly.

Since 2007, the heart specialist allegedly performed these unnecessary surgeries on thousands of patients, according to the Justice Department.

The heart specialist involved in the lawsuit, Dr. John R. Dylewski, reportedly no longer works for the Baptist Health hospital system, to which South Miami Hospital belongs.

Although the hospital agreed to the $12 million settlement, this is not an admission of guilt of any kind, spokespersons say.

“South Miami Hospital cooperated fully with the United States government to reach a settlement in this case,” wrote Yvonne Johnson, a physician and chief medical officer for South Miami Hospital in a statement. “The claims settled by the lawsuit are allegations only, and there has been no determination of liability. It is important for our patients to know that we are committed to the highest quality of care.”

Johnson offered further assurances, noting that “Dr. John Dylewski is not practicing at our hospital.”

Medicare Fraud Whistleblower Lawsuit Brought By Physicians

The Medicare fraud whistleblower lawsuit was originally brought forward by two South Miami Hospital physicians, James B. and James D.

The lawsuit claims that Dylewski performed medically unnecessary and costly procedures on patients suffering from irregular heartbeats. These procedures included echocardiograms, electrophysiology studies, and head upright tilt tests that were unnecessary for the treatment of these patients’ irregular heartbeats.

Instead, the procedures were meant simply to boost the doctor and hospital reimbursements from Medicare and other federally funded healthcare programs. The whistleblowers allege that, of the thousands of patients affected by Dylewski’s unnecessary surgeries, many were elderly.

According to the Medicare fraud whistleblower lawsuit, it was not just Dr. Dylewski who was in on the fraud. Rather, top Baptist Health executives were aware of this scheme as well, the lawsuit alleges.

For their role in bringing these allegations to light, the whistleblowers themselves will receive approximately $2.7 million of the total settlement money.

Interestingly, these were not the first employees of the hospital to file complaints about Dylewski’s practices, the lawsuit notes. But “the complaints fell on deaf ears,” leading finally to this Medicare fraud whistleblower lawsuit and its subsequent settlement.

Filing a Whistleblower Lawsuit

The government often relies on the help of whistleblowers to report and expose healthcare fraud. Whistleblowers are usually employees or former employees of companies, and report illegal activities against the government, including healthcare fraud.

A whistleblower’s role is very important, as they call attention to healthcare fraud on behalf of the government. It can be intimidating for an employee to blow the whistle on a current employer. Many employees are afraid that, by starting a whistleblower lawsuit, they will bring their employer’s ire and may even be fired.

However, there are laws in place to protect whistleblowers from these kinds of discriminatory actions. The government wants to protect whistleblowers that expose fraudulent activity.

As a reward, a whistleblower is generally given a substantial chunk of the settlement money from the lawsuit, as there would have been no lawsuit without the whistleblower first exposing the fraud. Whistleblowers are often given between 15 and 30 percent of the settlement money from a healthcare fraud lawsuit.

If you believe that your current or former employer is participating or has participated in healthcare fraud or other fraudulent behavior against the government, you may be able to become a whistleblower and call attention to this problem on behalf of the federal government by filing a lawsuit under the False Claims Act.