Boca Raton Regional Hospital has been accused by a former employee of cheating Medicare out of at least $2 million. In the lawsuit filed in U.S. District Court, Jeannette Lavoie claims hospital administrators intentionally used the wrong billing code to collect far more federal money for treating patients with heart problems than regulations allow. The lawsuit remained sealed for six months while the U.S. Justice Department weighed whether it would pursue the case. While federal attorneys decided not to, they could do so in the future. The lawsuit was filed under the False Claims Act, which allows citizens to sue to recover money for the government.
Under the Act, if Ms. Lavoie’s claims are correct, the hospital could be forced to pay three times the amount it overbilled Medicare. Lavoie could recover as much as 30% of whatever damages the hospital is forced to pay. Ms. Lavoie was director of case management at the hospital when she became concerned that the health care facility wasn’t properly reporting whether patients who received pacemakers, cardiac stents, angioplasties or other heart procedures were being treated on an inpatient or outpatient basis. In a random review of 30 patient charts, Lavoie’s department found 27 errors. When she brought her findings to hospital administrators, she claims they told her they were not going to resubmit bills. They expressed confidence auditors wouldn’t uncover the mistakes.
Between July 2006 and January 2008, when Ms. Lavoie left her job, the hospital submitted more than 600 fraudulent claims, the lawsuit alleges. While Ms. Lavoie didn’t leave her position “with a box of records,” it’s said to be unknown exactly how many false claims were submitted or over what period. In the first sealed lawsuit that was filed last year, the value of the fraudulent billing was set at $8 million. After additional records were obtained, the amount was reduced in an amended lawsuit that was filed in September. The exact amount of the claim will become clear as the hospital turns over records as the lawsuit proceeds.
Source: Palm Beach Post
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