Baptist Health to Settle False Medicare Claims For $3.7M; Whistleblower to Get $6.5K

Baptist Health Systems has agreed to pay $3.7 million to the United States Department of Justice to settle allegations that it violated the federal False Claims Act by filing false claims for reimbursement under the Medicare program, the U.S. Attorney’s Office announced earlier this week. 

Baptist Health Systems allegedly filed improper claims with the Medicare program by failing to disclose on the claim that the patient receiving treatment had another insurance policy that covered the care.  Under the law, a health care provider is required to disclose the fact that a patient has other insurance when it files its claim with Medicare.  The claim is processed under the other insurance policy and, in most cases, Medicare compensates the patient for whatever was paid for out of pocket (such as a deductible or copayment).   If the insurance company is slow to pay and the health care provider receives a double payment, then the health care provider must reimburse Medicare.

The lawsuit was originally filed by Norma Rivera, a former insurance auditor for Baptist, under the whistleblower provisions of the False Claims Act.  The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Rivera will receive $600,500 for her portion of the settlement as well as a full reimbursement from Baptist Health Systems for her legal fees.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who uncover fraud of every kind perpetrated against our government including, health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.