Recently, a Wall Street Journal article titled “Medicare Overbilling Probes Run Into Political Pressure” examined supposed Congressional meddling with a health care fraud investigation. According to the article, Congresswoman Sheila Jackson (D-Texas) contacted CMS administrator Marilyn Tavenner and encouraged her to “back down” on CMS’s health care fraud investigation of a hospital in Jackson’s district, Riverside General Hospital. The WSJ learned that soon after this alleged communication, Ms. Tavenner instructed her deputies to restore most payments to the hospital even as CMS was cooperating in a DOJ criminal investigation of the facility.
Shortly thereafter, Riverside’s CEO was indicted and later convicted in a $158 million healthcare fraud scheme, and the hospital was barred from Medicare. Prosecutors said the executive paid kickbacks to patient recruiters and to owners and operators of group care homes for delivering patients to Riverside facilities.
The timing of the events led to increased scrutiny of Congressional-CMS relations, both on and off Capitol Hill. However, lacking from this public debate/scrutiny, we believe, was an acknowledgement of the dedicated Justice Department attorneys and investigators who moved forward with their investigation of Riverside General Hospital.
More information for whistleblowers is located at the Nolan Auerbach & White website.