Over the last few years, the government has devoted substantial resources to pursue hospitals that inappropriately admit patients to inpatient stays. This month, the government intervened after initial declaration in a qui tam case against 14-hospital health system Prime Healthcare. The lawsuit included allegations that senior management would:
- criticize Emergency Department doctors and demand their termination if they were passing up opportunities to cause the admission of Medicare beneficiaries;
- request increased work schedules for Emergency Department doctors whose patients had a relatively high rate of admission;
- request decreased or discontinued work schedules for Emergency Department doctors whose patients had a relatively low rate of admission;
- tell Emergency Department doctors to find a way to admit all patients over 65 because they all have insurance; and
- tell Emergency Department doctors that an insured patient who would be in the Emergency Department for more than two hours waiting for test results should be admitted, but an uninsured patient could stay in the ED for 6 to 8 hours awaiting results and then be discharged.
Emergency Department physicians and directors of case management are in the best position to evidence such wrongdoing. For these individuals, substantial whistleblower rewards might be available.
More information for potential whistleblowers is located at the Nolan Auerbach & White website.