Medical Firm Agrees To Pay $14.5 Million To Settle Medicare Overbilling Allegations

162017_132140396847214_292624_nOn July 3, 2013, the U.S. Department of Justice announced that Tacoma, Washington-based Sound Inpatient Physicians Inc. (“Sound Inpatient”), a provider of hospitalists and other physicians to 70 hospitals and post-acute facilities in 22 U.S. states, has agreed to pay $14.5 million to settle federal allegations that it overbilled Medicare and other federal health care programs. Sound Inpatient employs more than 700 hospitalists and post-acute physicians.

Hospitalists are physicians who provide care exclusively to hospital inpatients and have no office or outpatient practice. They are typically trained in internal medicine. The claims against Sound Inpatient alleged that between 2004 and 2012, it knowingly submitted to federal health benefits programs inflated claims on behalf of its hospitalist employees for higher and more expensive levels of service than were documented by hospitalists in patient medical records.

The settlement resulted from a False Claims Act federal lawsuit (qui tam action) brought by a whistleblower who was a former employee of Sound Inpatient. Under the qui tam provisions of the False Claims Act, which permits private citizens to file federal civil actions on behalf of the United States and share in any recovery that the federal government receives, the whistleblower will receive $2.7 million of the $14.5 settlement reached with Sound Inpatient.

In announcing the settlement with Sound Inpatient, the Acting Assistant Attorney General for the Civil Division of the U.S. Department of Justice stated, “Physicians who participate in Medicare and other federal health care programs must document and bill for their services accurately and honestly. The Department of Justice is committed to ensuring that Medicare and other federal funds are expended appropriately.”

The U.S. Attorney for the Western District of Washington added, “Fraudulently inflated billing of government health care programs puts those programs at risk, and impacts the system’s ability to care for the neediest in our communities. During this time of tight government budgets, we will do all we can to make sure everyone plays by the rules and does not run up the taxpayers’ tab.”

The federal whistleblower lawsuit is captioned United States of America ex rel. Craig Thomas v. Sound Inpatient Physicians, Inc. and Robert A. Bessler, Civil Action No. C09-5301RBL (W.D. Wash.).

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We have previously reported on False Claims Act qui tam actions in this blog involving miscreant health care providers and unscrupulous medical equipment providers who allegedly overcharged Medicare and other federal health care programs for services and medical equipment they provided, and sometimes for services and equipment that were never provided. While it appears that the qui tam provisions of the False Claims Act have resulted in private citizens coming forward to become whistleblowers as to the financial wrongdoing of their former or present employers that have resulted in millions of dollars being recovered by the federal government, and millions being paid to whistleblowers for their efforts on behalf of the federal government, it is clear that the availability of billions of dollars of federal money through federal health care programs remains a strong attraction to those bent on unethical and criminal activities – where there’s money to be made, there are those who will knowingly break the law in order to enrich themselves at the expense of those who are intended to benefit from the federal health care programs.

If you are aware of financial wrongdoing by a health care provider or a medical equipment provider who is fraudulently billing Medicare or other federal health care programs, and the information regarding the wrongdoing is not in the public domain and an investigation into the illegal matter has not yet begun, you may become a whistleblower regarding the illegal activity, thereby becoming entitled to share in a portion of any recovery that the U.S. may receive due to your whistleblower efforts.

Click here to visit our website to be connected with whistleblower lawyers (qui tam lawyers) in your U.S. state who may assist you with your whistleblower claim and represent you in a whistleblower civil action (qui tam action), or telephone us toll-free at 800-295-3959.

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This entry was posted on Saturday, September 7th, 2013 at 8:31 am. Both comments and pings are currently closed.

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