Today in Tampa, FL, the United States government reached a settlement agreement with Adventist Health System regarding allegations of multiple False Claims Act violations. Morgan & Morgan’s Complex Litigation Group represented the qui tam relator, Heather Huddleston.
Chemotherapy mismanagement allegations
Huddleston, a nurse who formerly worked at Adventist centers, filed the lawsuit in February 2013 alleging various forms of misconduct Adventist may have perpetrated from 2007 to 2011. She accused Adventist of re-using single-use vials of chemotherapy drugs.
Single-use vials can only be administered to one patient; re-opening them and using remaining portions of the chemotherapy drugs inside on subsequent patients is potentially dangerous. The contents of the vials can be contaminated by harmful agents and can cause considerable risk to patients.
Patients undergoing chemotherapy are particularly vulnerable to possible contaminants, as their immune system can already be severely compromised.
In addition to the alleged mismanagement of chemotherapy treatments, Adventist was accused of improper administration of platinum-based drugs and the upcoding of infusion services. Certain Adventist patients may have required medical attention as a result of the hospital’s alleged misconduct.
The allegations constitute False Claims Act violations because they resulted in the submission of improper or inaccurate invoices to Medicare, TRICARE and the Federal Employees Health Benefits Program.
Adventist has agreed to pay a $2.09 million settlement in response to these allegations. The healthcare corporation had voluntary admitted to some of the allegations in 2012, so the $819,828.32 penalty they’d agreed to at that time will be applied as a credit to this settlement.
In reward for her role as a qui tam relator, Huddleston will receive $376,452. The False Claims Act entitles whistleblowers a reward of 15%-30% of any recovery over $1 million when a legal resolution is successfully achieved.
Past Adventist cases
This is Morgan & Morgan’s second recent success story in a government lawsuit against Adventist. In March of last year, our Complex Litigation Group attorneys helped the government recover a separate settlement from Adventist in regards to possible False Claims Act violations.
In an unfortunate correlation, that case also involved the treatment of cancer patients. Adventist had allegedly allowed unqualified employees to administer radiation treatments to patients. This type of therapy kills cancer cells by targeting them with intense, regulated doses of radiation. The hospital system allegedly submitted fraudulent invoices to the government claiming that qualified medical professionals had treated Medicare and TRICARE patients.
Morgan & Morgan filed that lawsuit on behalf of a qui tam relator who had worked at Adventist hospitals as a radiation oncologist. He was awarded $1,082,500 for his role, while the government recovered $5,412,502 from the settlement.
Federal healthcare programs and fraud
Medicare, Medicaid, TRICARE and other government healthcare programs have strict and extensive guidelines because they operate largely on taxpayer dollars. To dissuade and address fraud, any intentional violation of these guidelines is subject to civil and sometimes criminal penalties.
Certain types of fraud are so commonplace in some healthcare organizations that they may seem legal or harmless. Practices like routinely waiving co-pays, upcoding, and paying kickbacks are very widespread, but they are prohibited under the False Claims Act.
That’s why it’s important for healthcare employees to stay up-to-date on the types of fraud that can occur, as well as the potential legal repercussions for committing each type of fraud.
The role of whistleblowers in False Claims Act cases
Following today’s resolution, whistleblower attorney John Yanchunis, a partner with our Complex Litigation Group, applauded the qui tam relator for her bravery and integrity. “The case could not have been filed without the perseverance of the firm’s client, Heather Huddleston, who, while employed by Adventist, repeatedly complained to management of the hospital to stop the practices which were at the center of her lawsuit.”
Healthcare companies sometimes report False Claims Act violations on their own accord, but it is otherwise very difficult for the government to catch every instance of Medicare and Medicaid fraud without the assistance of healthcare providers or other industry insiders.
Under the False Claims Act, citizens have a legal right to report wrongdoing that defrauds the federal government. It is not legal for employers to retaliate against whistleblowers who follow the appropriate reporting procedures. Any retaliation that is committed may entitle the whistleblower to additional compensation and legal resolution.