A recently settled whistleblower lawsuitresolved claims that a Maryland health system committed Medicare fraud.

According to the Department of Justice, the Anne Arundel Medical Center (AAMC) in Maryland will pay $3.154 million to resolve claims that they violated the False Claims Act by defrauding Medicare by filing claims for medically unnecessary services. The fraud reportedly lasted for at least eight years.

“Companies that submit false bills to the government must be held accountable. The United States Attorney’s Office is committed to taking the steps necessary to protect Medicare and other federal healthcare programs from fraud and abuse and recover taxpayers’ money,” said U.S. Attorney Robert K. Hur in a Department of Justice statement.

In addition to paying $3.154 million, the settlement includes a 5 year agreement that AAMC will maintain multiple monitoring and training programs to make sure that the billing issue does not occur in the future. $473,100 of the $3.154 million settlement will reportedly be given to the former AAMC employee who filed the whistleblower suit under the False Claims Act according to The Capital Gazette.

Plaintiff Dr. Barbara M. worked as a clinical pharmacist for 25 years at AAMC. In 2007, after a successful career at the medical center, the regional health system reportedly moved Barbara to work in the system’s new outpatient clinic which dealt with patients on blood thinning medications. Four years after she was transferred, Barbara was reportedly promoted to managing the Anticoagulation Clinic.

However, while she worked at the clinic Barbara allegedly witnessed instances of Medicare fraud. The clinic allegedly overbilled Medicare for services that were not medically necessary. When Barbara brought concerns to her superiors, she was reportedly ignored and was eventually fired in 2014.

AAMC reportedly maintains that it has done nothing wrong and only settled the case to avoid the risks and costs associated with continuing their legal battle in court.

“We believe AAMC practices complied with federal laws and regulations and contributed to the improved health of our patients,” a hospital representative said in a statement, according to The Capital Gazette.

“However, in the interest of avoiding litigation and incurring additional legal expenses, we decided it was in our best interest to settle.”

Whistleblower lawsuits filed under the False Claims Act provide a way for private citizens to hold businesses accountable for Medicare fraud and other types of fraudulent behaviors. Because plaintiffs in whistleblower lawsuits bring their claims on behalf of the government, the Department of Justice can “unseal” these cases at any time by deciding whether or not to intervene. These are also known as qui tam lawsuits.

If the government does not intervene, plaintiffs are left to pursue their claims individually. If the government decides to intervene, they can take over the process and may be more likely to reach a settlement with the company in question. Should a whistleblower lawsuit result in a settlement, the plaintiffs who brought the claims are usually entitled to a portion of the settlement.

A  whistleblower lawsuit under the False Claims Act can be filed if individuals have knowledge of businesses defrauding Medicare, Medicaid, Tricare, or other government programs. Whistleblower lawsuits can also be filed in the case of military contracts.

This article is not legal advice. It is presented
for informational purposes only.