The Department of Justice (“DOJ”) recently settled a False Claims Act (“FCA”) lawsuit with Brattleboro Memorial Hospital (“BMH”). Pursuant to the settlement, BMH agreed to pay $1.65 Million to the United States and the State of Vermont to resolve allegations that the company violated the False Claims Act through submitting false or fraudulent claims to Government Healthcare Programs, including Medicare and Medicaid.

Located in Vermont, BMH is a community hospital, whose services include out-patient laboratory work. According to the Government’s allegations, BMH knowingly submitted or caused to be submitted a number of outpatient laboratory claims between January 2012 through September 2014, lacking necessary documentation to support reimbursement by Medicare and Medicaid. Specifically, clinicians’ orders for laboratory tests were not adequate to document the diagnosis code included on the billing claim form. BMH stated in a press release that it had “voluntarily self-disclosed to the Office of Inspector General for the U.S. Department of Health and Human Services, that BMH received overpayments as a result of this billing issue.”

The whistleblower qui tam lawsuit that originally brought the wrongdoing to light was filed by relator Amy Beth Main, who was a former employee of the hospital’s financial services department. According to her lawsuit, during her employment as an administrator, she noticed irregular, inappropriate and improper billings. The relator Main brought the qui tam lawsuit under the FCA, which allowed her to act on behalf of the U.S. government in exposing the government programs fraud.  Under the FCA, relators receive a portion of the money that has been recovered by the government, which is known as the relator’s share. Whistleblower Main is expected to receive between 15 and 20 percent of the settlement, as a reward for exposing the healthcare fraud scheme.