Vanderbilt Medical Center in Nashville has been accused of participating in fraud against the government by overbilling Medicaid and Medicare and submitting fraudulent claims.

Recently, Vanderbilt Medical Center has agreed to pay $6.5 million to the government in response to allegations that it made a practice of overbilling Medicaid and Medicare for procedures done in the hospital.

Nashville Public Radio reports that whistleblowers alleged that Vanderbilt Medical Center regularly charged the higher rates for attending physician when it actually was an unsupervised medical resident performing the procedure. This included both operating room services and ICU services.

Additionally, Vanderbilt Medical Center has been accused of overbilling Medicaid and Medicare for unnecessary anesthesia. This allegation claims that Vanderbilt billed the government for anesthesia that did not meet the criteria for medical direction.

Claims also include billing for the same surgeon working on different surgeries simultaneously. In essence, the government was allegedly billed overlapping surgeries in different operating rooms by the same performing surgeon.

One of the attorneys for Vanderbilt stated that Vanderbilt Medical Center does not admit to overbilling Medicaid and Medicare, but that it agreed to the $6.5 million settlement to avoid more time in court.

He said in a statement, “All parties agree that the allegations in the lawsuit have neither been proven nor disproven. While the plaintiffs and federal government found no evidence of wrongdoing, litigating these types of cases is very expensive and time consuming.”

Vanderbilt Medical Center has also agreed to submit to a third party audit including the effectiveness of their Medicaid and Medicare billing policies, procedures and practices.

The main issue behind this whistleblower lawsuit and settlement is that Vanderbilt violated the federal False Claims Act.

The False Claims Act, or FCA, lets a private individual or an employee that has knowledge that fraud against the government has occurred file a qui tam lawsuit against that company.

The FCA protects the whistleblower from retaliation by the company or business responsible for fraud. In essence, that company cannot fire or in other ways punish the individual for their participation in the qui tam lawsuit.

Section 3730(h) of the False Claims Act states, “Any employee, contractor, or agent shall be entitled to all relief necessary to make that employee, contractor, or agent whole, if that employee, contractor, or agent is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment because of lawful acts done by the employee, contractor, agent.”

If the company does retaliate against the whistleblower, the whistleblower can seek compensation for any damages, court costs and fees, reinstatement of their old job if they were terminated and twice the amount of back pay they would have received had they retained their position.

In this Vanderbilt Medical Center case, the $6.5 million is paid to the government but the whistleblowers may see some of that money. They may receive up to 30 percent of the total award.

The attorneys for the whistleblower plaintiffs said to PR Newswire, “The Plaintiffs are conscientious former VUMC physicians who blew the whistle primarily because of their concerns about patient safety at VUMC.  We are hopeful the settlement we have reached today and the audit that will be performed will go a long way in preventing any possible future fraud and improving patient safety at the Hospital for many years to come.”