By Staff
From staff reports
Jan. 20, 2001
Meridian-based Rush Health Systems Inc. and three of its affiliates will pay $1.05 million to settle a whistle blower lawsuit filed by a former employee, U.S. Attorney James Tucker announced Friday.
And, Donna May, the former Rush employee who filed the lawsuit in 1997 under the federal False Claims Act, will receive $220,500 of the settlement. The so-called whistle blower law allows sharing any monetary recovery with the citizen who first reports fraud against the government.
In a statement released Friday, Rush confirmed the settlement in a case involving reimbursement of Medicare claims without admitting any wrongdoing. The statement said the settlement was preferable to engaging in "protracted and costly litigation.
The lawsuit against Rush, filed by May in November 1997, alleged Rush submitted claims to Medicare using the Medicare provider numbers of physicians who did not provide the billed services. Investigators reportedly identified about $2,500 in such improper billings.
According to May's complaint, in some instances Rush would use a physicians' Medicare number, without his or her knowledge, to bill for services provided by other physicians who were not eligible to bill Medicare. And, in some instances, physicians' numbers would be used to bill for the services of nurse practitioners.
Assistant U.S. Attorney Cliff Johnson, who handled the case for the federal government, said in addition to the allegations contained in May's complaint the settlement resolves the government's claims concerning another issue that arose as part of the investigation.
According to Johnson, Rush received improper payments from Medicare as a result of seeking and receiving Medicare reimbursement for management fees Rush paid to Platinum Medical Management of Choctaw, Ala. to manage Rush's Alabama-based home health agency, Primary Home Health Care.
Johnson said Rush included more than $500,000 in management fees paid to Platinum in its reimbursement requests to Medicare from 1996-1999. The government alleged Rush knew or should have known that the services actually provided by Platinum did not warrant payment from Medicare.
Rush's statement said the health care system believes "our actions with the outside management company were legal and made in the best interests of patient care."
Both Rush officials and Tucker noted that Rush's corporate compliance efforts played a role in settlement negotiations.
Since 1996, Rush has engaged in an extensive system of education and training for its employees on proper business and billing practices.