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Case
Studies Hospitals
In 2003, the hospital corporation, HCA, Inc. (formerly Columbia/HCA Healthcare Corporation), reached a $4 million settlement with the Department of Justice arising from a lawsuit brought by Getnick & Getnick on behalf of a former hospital reimbursement manager alleging that HCA defrauded Medicare by submitting claims for reimbursement relating to Procuren, a biologic product derived from platelets in the patient’s blood. Procuren is not reimbursed by Medicare because its safety and efficacy has not been established to Medicare’s satisfaction. The settlement was part of a $631 million settlement with HCA. The government’s investigation into HCA involved, at its height, more than 25 qui tam lawsuits, most of which were not pursued by the Department of Justice. G&G’s client was one of eight whistleblowers whose cases were joined by the Department of Justice in reaching the settlement. Curative Health Services, Inc., which provides wound care services to hospitals nationwide, agreed in 2001 to pay $16.5 million in settlement of allegations that it caused hospitals to submit fraudulent cost reports to the United States containing false statements regarding the costs of advertising and marketing for the wound care center. The settlement resulted from qui tam lawsuits filed by Getnick & Getnick in cooperation with a Florida law firm on behalf of two whistleblowers, one a former hospital Chief Financial Officer and the other a former hospital reimbursement manager. The whistleblowers received 19.5% of the recovery. In 2001, the national hospital chain Tenet Healthcare paid $175,000 to settle allegations that it falsely billed three times the legitimate charges for outpatient surgical pathology procedures. Although a small dollar recovery, this case, which was brought by Getnick & Getnick on behalf of a Florida retiree who noticed the multiple billing on his own medical bills, exposed Tenet’s non-compliance with a pre-existing government-imposed Corporate Integrity Agreement and put a stop to the overbilling which had been going on for more than six years at considerable expense to Medicare beneficiaries and private-pay patients. The whistleblower received 21% of the recovery. See “First Beneficiary Whistleblower Case Settles Over Hospital’s Pathology Claims,” Report on Medicare Compliance, Vol. 10, No. 16, May 10, 2001.
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