On July 26, 2013, the United States Justice Department announced that Dubuis Health System and Southern Crescent Hospital for Specialty Care, Inc. (Southern Crescent) have agreed to an $8,000,000 settlement with the U.S. government.  The settlement resulted from allegations that Dubuis Health System and Southern Crescent submitted false claims to Medicare.

Dubuis Health System manages long-term acute care hospitals, including Southern Crescent.  Southern Crescent is a long-term acute care hospital situated in Riverdale, GA.  Long-term acute care hospitals are those facilities which are certified to care for patients with more complex medical needs and who remain in the hospital for more than twenty-five days.  These types of hospitals receive greater monetary reimbursements from Medicare compared to a typical, acute care hospital.

Accordingly to the allegations in a False Claims Act lawsuit brought on behalf of the United States government, over the span of six years, Dubuis Health System and Southern Crescent engaged in a variety of practices that defrauded the Medicare program.  First, hospital administrators purportedly extended patients’ hospital stays beyond the time that was medically necessary, resulting in  increased the Medicare reimbursement payments that Southern Crescent, and consequently Dubuis Health System, received.  Moreover, Dubuis allegedly  ensured that Southern Crescent could maintain its status as a long-term acute care facility, even though the hospital did not necessarily deserve that classification.  Second, Southern Crescent allegedly admitted patients who initially did not meet the requirements of entry into a long-term acute care hospital.  Finally, according to the lawsuit, these healthcare providers billed for equipment, such as ventilators and feeding pumps, even if the equipment was no longer medically necessary for the patient.

These types of deceptive practices cause the costs of Medicare services to soar.  Not only do higher Medicare costs waste government resources, but they also limit healthcare programs from serving the citizens of the United States who have the greatest need for federal assistance when paying their medical bills.

Thankfully, the United States government has established ways in which people can expose instances of healthcare fraud.  Under the False Claims Act, private citizens can file qui tam lawsuits alleging false claims on behalf of the U.S. government.  The person who brings instances of fraud to the government’s attention is known as the relator or False Claims Act whistleblower.  Private citizens often have first-hand knowledge of firms, contractors, or other individuals committing fraud against the government.  The False Claims Act encourages those citizens to come forward and relate their knowledge to the proper authorities.  Healthcare Whistleblowers in False Claims suits deserve our applause because they often risk their livelihood if they are still employed by companies committing fraud.  Despite the fact that they take on a personal risk, it is worthwhile for whistleblowers to come forward with their information because not only do they help eradicate fraud, but they also receive a significant proportion of settlements in False Claim Lawsuits.

The healthcare whistleblower in this case was a registered nurse named Darlene Tucker.  In 2006, Ms. Tucker started her employment with Southern Crescent Personnel.  Two years later, she became the charge nurse for Southern Crescent.  Over the tenure of her employment, Darlene Tucker realized that her employers were engaged in an ongoing scheme of filing false claims for Medicare reimbursement.  She brought the attention directly to her superiors, but they continually rebuffed Ms. Tucker for her allegations.  In light of this failure of management to rectify the company’s policies, Darlene Tucker realized she must take legal action to reveal her employers’ fraud.  In June 2009, she filed a complaint against Dubuis Health System and Southern Crescent.

As a result of this settlement, Ms. Tucker will receive $2,160,000 of the United States’ recovery.