Halifax Health Whistleblower/Qui Tam Case Will Go To Trial

Friday, December 6, 2013
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Federal Judge Gregory A. Presnell has ruled that Halifax Health Medical Center, a Daytona Beach hospital, illegally compensated six (6) oncologists, violating the federal Stark Law. The case must still go to trial on the amount of damages and other legal issues. The Stark Law bars physicians from getting extra cash or benefits from patient referrals through kickbacks, split fees and other under-the-table arrangements. The announcement was made on November 14, 2013. The issue of whether the hospital knowingly filed any false claims is one which a jury must decide.

Click here to read The Daytona Beach News-Journal article
.

The whistleblower lawsuit stems from a 2009, complaint filed by a former compliance officer for Halifax. The Department of Justice (DOJ) joined the case in 2011. To read a previous blog on the DOJ joining the lawsuit, click here.


Claims Against Halifax.

Halifax is accused of submitting around 75,000 Medicare claims that were tainted because they involve care provided by the doctors illegally compensated. According to Modern Healthcare, in March 2014, a jury will decide whether or not the hospital intentionally defrauded Medicare. If the hospital is proven to have knowingly violated the Stark Law, the potential damages in the case could end up being as much as $1.1 billion. To read the Modern Healthcare article, click here.

The federal Stark Law was enacted to ensure that referrals are made for medical reasons only, without financial motives. Click here to read more on the Stark Law.


Three Halifax Neurosurgeons Waiting on Ruling by Judge.

In addition to the six oncologists, the whistleblower lawsuit alleges Halifax improperly compensated three neurosurgeons as well. However, the judge has not weighed in on their employment arrangements yet, according to The Daytona Beach News-Journal.


Most Qui Tam Claims Filed by Employees.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.


Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.


Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?

What are your thoughts on this trial? What do you think about the more than $1 billion in potential damages? How will that affect the hospital? Please leave any thoughtful comments below.


Sources:

Carlson, Joe. “$1 Billion Stark Case Against Fla. Hospital Headed to Trial.” Modern Healthcare. (November 25, 2013). From: http://bit.ly/18lyGUu

Swisher, Skyler. “Judge: Halifax Health Illegally Paid Doctors.” The Daytona Beach News-Journal. (November 14, 2013). From: http://www.news-journalonline.com/article/20131114/news/131119728


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


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12/6/2013

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