Community Health Systems, the nation's largest for-profit acute care hospital company, has settled a series of whistleblower suits alleging Medicare and Medicaid fraud for $98 million.  The basis for the suit were as follows: the company offered illegal kickbacks to doctors that ordered or directed unnecessary tests or procedures be done on patients, which had the effect to inflating the bills sent to and paid by Medicaid and Medicare.  The suits were brought by an emergency room physician as well as two other doctors, who claimed also that the contract of their physicians' group was not renewed after they opposed the fraudulent practices.

Source: Mooresville (N.C.) Tribune: Lawsuits Against Hospitals' Owner Settled for $98 Million

The whistleblower suits were filed under the federal False Claims Act, Anti-Kickback statute and North Carolina's own False Claims Act. The federal law allows whistleblowers to file suit against companies and/or contractors that defraud the federal government.  This case presents a fairly common scenario in these types of cases: a large, for-profit hospital company paid illegal kickbacks to doctors who ordered unnecessary tests and procedures on patients, all of which increased the monies paid the hospital company by Medicare and Medicaid fraud. In other words, bilking Medicare and Medicaid by fraud.

Lexington, Kentucky whistleblower lawyer Robert Abell represents individuals and employees in Medicare fraud and Medicaid fraud cases; contact him at 859-254-7076. 

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