Heartland Regional Medical Center, also known as Mosaic Life Care, is facing a whistleblower retaliation lawsuit by a woman alleging the company violated the False Claims Act (FCA).

Plaintiff Debra C. is filing the whistleblower retaliation lawsuit in Missouri federal court. The lawsuit was filed on May 25, 2018.

According to the whistleblower retaliation lawsuit, Debra was employed by Heartland for nearly 40 years but began working for the medical center in 2007 as a medical coder. A medical coder performs functions that ensures that medical billing and procedures are coded in accordance with Medicare guidelines.

In November 2016, she says, she began to have to report to the relatively new Data Entry Manager and Clinic Coding Manager of the center. During late 2016, she says that she discussed with the Data Entry Manager that reimbursement for a coding rule could only be done under certain criteria and qualifications.

Specifically, a coding rule would not “allow reimbursement for a fractional flow wire … unless the fractional flow wire was conducted on the same day by the same doctor who conducted a diagnostic Catheterization of the heart on the patient who was the subject of the reimbursement,” the whistleblower retaliation lawsuit states.

However, the Data Entry Manager asked Debra to put the charges through anyway. Debra resisted and charges began to back up. Even though she was deeply conflicted, she began to proceed to release charges.

However, to protect herself in case of a future audit stemming from fraudulent billing, she says that the “coding entry included a statement that she was only releasing the claims …” per the Data Entry Manager and Clinic Coding Manager of the center.

In May 2017, she was informed that she was being removed from her position as she did not have the proper certification to do that work. Her termination was signed off by the Data Entry Manager.

The whistleblower retaliation lawsuit was filed on a count of a violation of the False Claims Act, state law wrongful discharge and violation of the MHRA based on age and retaliation.

Debra demands a trial by jury.

Overview: Whistleblower Retaliation Lawsuit

Qui tam lawsuits are a type of whistleblower lawsuit filed and brought under the False Claims Act. The Act, also called the “Lincoln Law” is an American federal law that rewards whistleblowers in cases where the government retrieves money lost to fraudulent activity.

The name “qui tam” comes from the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which translates to “he who brings an action for the king as well as for himself.”

Through whistleblower claims, the U.S. government is able to inhibit many different kinds of fraud that may have to do with Medicaid and Medicare as well as defense contractor fraud.

Whistleblower lawsuits have been able to retrieve billions stolen from the U.S. Treasury and taxpayers. Under whistleblower lawsuits, whistleblowers are protected because of the personal and professional risks they take when exposing fraudulent activity to the U.S. government.

The Whistleblower Retaliation Lawsuit is Case No. 5:18-cv-06073-RK, in the U.S. District Court for the Western District of Missouri.