Hospital Worker Receives Nearly $5 Million Reward in Whistleblower Reward Over Hospital Billing Fraud

Tuesday, August 05, 2008 by: David Gutierrez, staff writer
Tags: hospitals, health news, Natural News

(NaturalNews) A former nurse who filed a whistleblower lawsuit against a hospital for defrauding Medicare has been awarded $4.94 million by the court.

The award comes out of the $26 million that Saint Joseph's Hospital of Atlanta Inc. and Saint Joseph's Health System Inc. agreed to pay Medicare in exchange for having the lawsuit against them dropped.

Saint Joseph's Hospital, founded in 1880, is the oldest hospital in Atlanta. According to the lawsuit, the hospital submitted numerous Medicare claims between 2000 and 2005 that improperly billed outpatient visits as "inpatient admissions." This led to the hospital receiving substantially higher payments from Medicare than it was entitled to.

Registered nurse Tami Ramsey attempted to bring the improper billing procedures to the attention of doctors and supervisors while she worked at the hospital, but says that no one expressed any interest in the problem. Frustrated with what she felt was a hospital culture tolerant of mistakes, Ramsey went to the federal government and began gathering information for the whistleblower lawsuit.

According to Saint Joseph's spokesperson Lynn Peterson, the hospital leadership was unaware of the improper billing, which was done by doctors and other employees. These employees believed they were following proper procedure, she said.

Kirk Wilson, president of Saint Joseph's, said that from now on, billing will be handled by management nurses who have received extensive training in Medicare billing procedures, and who are updated regularly on rules changes.

According to Lynn, the hospital will not be hurt by the $26 million expense, because it has been saving up money for the past two years in expectation of this moment.

"Because we've been able to anticipate [the expense], and accrue it, and put it away in reserves, it's not going to affect operations at all," she said.

Saint Joseph's annual revenue is estimated at $400 million.