Halifax Health Reaches Record-Setting Settlement in Whistleblower/Qui Tam Fraud Case

Monday, March 10, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

At the eleventh hour Halifax Health Medical Center, a Daytona Beach hospital, agreed to pay a record-setting $85 million settlement in a whistleblower/qui tam lawsuit. The lawsuit alleged more than a decade of illegal compensation to doctors, violating the federal Stark Law, and Medicare fraud. According to the Orlando Sentinel, on March 3, 2014, Halifax and the U.S. Department of Justice (DOJ) reached the tentative agreement just as jury selection was set to begin.

To read the entire article from the Orlando Sentinel, click here.

The settlement requires Halifax to pay the settlement amount over a period of five years, in addition to attorneys' fees. Halifax must also agree to a corporate integrity and compliance program to ensure another incident does not happen again.


Claims Against Halifax Split Into Two Trials.

Due to the complexity of this case, the whistleblower/qui tam lawsuit was split into two trials.

This trial would have focused on allegations that payments made to six oncologists and three neurosurgeons violated the federal Stark Law. 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.

The second trial is set to go forward in July 2014. This trial will focus on allegations that the hospital billed Medicare for inpatient hospital care in cases where the medical need was not documented. The DOJ did not join this case. This part of the false claims case could result in damages and penalties of up to $400 million, according to Modern Healthcare.

To read the entire Modern Healthcare article, click here.


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 do you think about the settlement? Was it a good decision to settle? Do you think the second trial will go to court? Please leave any thoughtful comments below.


Sources:

Carlson, Joe. "$85M Settlement Reached in Florida Stark Case." Modern Healthcare. (March 3, 2014). From: http://bit.ly/1drATxA

Jameson, Marni. "Halifax Health Settles Fraud Case."
http://www.orlandosentinel.com/health/os-halifax-medicare-case-settles-20140303,0,255341.story


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.


Tag Words: defense attorney, defense lawyer, Department of Justice (DOJ), False Claims Act, FCA, Florida Medicare, fraud defense, fraud prevention, fraud schemes, government health programs, Halifax Hospital, legal representation, Medicare, Medicare fraud, Medicare overbilling, qui tam, qui tam attorney, qui tam lawsuit, qui tam lawyer, stark law, Stark Law violations, whistleblower, whistleblower lawsuit, whistleblower lawyer, whistleblower protection, health law firm, The Health Law Firm


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3/10/2014

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