Shands Health Care System has agreed to pay $3.25 million to settle outstanding claims that six of its Florida hospitals submitted improper outpatient billing to the government which resulted in overpayments from Medicaid, Medicare and TRICARE. This settlement comes on the heels of a $26 million settlement in August of 2013, which resolved additional claims by the same whistleblower also related to improper patient admissions.
James Hoyer Law Firm Partner Christopher Casper served as co-counsel for whistleblower Terry Myers, along with Attorney Marlan Wilbanks, of the Wilbanks and Bridges Law Firm.
Mr. Myers filed the suit in the Middle District of Florida in April of 2008, naming Shands Health Care System and six of its Florida Hospitals: Shands Alachua General Hospital; Shands Jacksonville Medical Center, Inc.; Shands Teaching Hospital and Clinics, Inc., d/b/a Shands at the University of Florida; Shands at Lakeshore, Inc.; Shands Live Oak; and Shands Starke.
In regards to the remaining allegations following the $26 million settlement, Myers contended that Shands knowingly submitted observation claims to Medicare, Medicaid and TRICARE for certain services and procedures which Shands knew or should have known that physician orders were missing or otherwise deficient for the charges billed.
Myers is the founder and President of YPRO Corporation. The company is a nationwide healthcare consulting firm that was hired by Shands in 2006 and 2007 to conduct audits to determine if Medicare and Medicaid rules were being followed. Serious billing, coding, and compliance issues were uncovered by the whistleblower’s company and relayed to Shands Corporate Executives and Shands Compliance officers. Mr. Myers felt compelled to take action by filing the whistleblower suit after Shands failed to correct the problems and self-report the overpayments to the government.
To settle the out-patient/observation claims, Shands will pay the United States $3.14 million for the federal portion of the settlement and an additional $103,668 to the State of Florida for the state portion of the settlement.
The lawsuit was filed under the federal False Claims Act (FCA) and the Florida False Claims Act. The False Claims Act allows private citizens to bring civil actions on behalf of the government in order to recover taxpayer money when fraud is suspected. If a case is successful, the whistleblower is entitled by law to recover money from the Defendants.