A Southern California hospital, El Centro Regional Medical Center, has agreed to pay $2.2 million to settle an FCA qui tam action, alleging that the hospital fraudulently inflated its charges to Medicare patients to obtain larger reimbursements from the federal health care program. Specifically, the whistleblower alleged that the hospital submitted false Medicare claims for short inpatient admissions, usually of one day or less, when the services should have been billed on an outpatient “observation” basis or as emergency room visits. The whistleblower will receive $375,000 as his share of the recovery.
All too often, dishonest hospitals pad their Medicare bills by miscoding procedures or by exaggerating the duration of hospitalizations. This misinformation is difficult to detect, unless a hospital insider steps forward to report the true state of affairs. The federal False Claims Act provides an avenue for private citizens who want to halt fraudulent health care billing practices.