Reporting Medicare fraud paid off for hospital administrator Randi Ferrare, who will get a $1.8 million Medicare fraud reward.  The reward is her share of the $10.1 million government settlement with Morton Plan Health System.

Ferrare brought a Medicare Whistleblower suit under the Federal False Claims Act, alleging that the Florida hospital system over-billed Medicare.  Hospitals affiliated with Morton Plant Health Care billed certain cardiac procedures as inpatient care, when it should have been billed on a lower cost outpatient basis.

The rates Medicare pays for inpatient care are much higher than for outpatient and observational care.  When patients are observed to see if they should be admitted as inpatient, the proper billing codes are at the observational rate.  According to the government, Morton Plant improperly billed such observational care as inpatient care. The over $10 million settlement approximates the amount Medicare overpaid between July 2006 and July 2008.

“Overbilling the government for routine procedures wastes valuable resources that could be used to care for other patients,” said Stuart F. Delery, Principal Deputy Assistant Attorney General for the Justice Department’s Civil Division.   “At a time when we are trying to reduce public spending, it is especially important to ensure that hospitals do not overcharge the government by improperly inflating their billing.”

Ferrare’s Medicare whistleblower complaint was filed only against the Morton Plant hospital network.  However, the government investigation expanded to include two other affiliated hospitals, St. Anthony’s and St. Joseph’s.

In settling the allegations, the hospital systems admits to no wrongdoing.  It faults complexities in Medicare billing and coding for the alleged discrepancies.  It also points to medical developments during the time period that allowed more procedures to be done on an outpatient basis.

If you have non-public information about improper billing or other heath care fraud, a Medicare whistleblower attorney can assist you in Reporting Medicare Fraud.  We can help evaluate whether you may be eligible for a Medicare fraud reward and guide you through the steps that need to be taken.  Call 1-877-255-2676 today to report Medicare fraud or contact us.

Source: Department of Justice press release

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