Hospital Countersues FCA Whistleblower for Failing to Report Information to Company First
Tuesday, December 31, 2019
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 13, 2019, a West Virginia hospital facing a whistleblower lawsuit countersued a former employee who filed the False Claims Act (FCA) lawsuit against the health system. Wheeling Hospital alleges that the former executive, who is the whistleblower/relator in the lawsuit, breached his fiduciary duty to the company by failing to report the unlawful conduct internally, first. Instead, he used the information as the basis for his whistleblower claim. In the countersuit filed in the U.S. District Court for the Northern District of West Virginia, the Hospital accuses the former executive-turned-whistleblower of attempting to 'extort a settlement' and filing the FCA whistleblower suit as an act of revenge.
The Whistleblower's Complaint.
The whistleblower, a former accountant and senior executive at Wheeling Hospital, was discharged in August 2015. In December 2017, he filed a complaint under the qui tam provisions of the False Claims Act (FCA). He alleged the hospital violated the federal Anti-Kickback Statute (AKS) by paying kickbacks to physicians for patient referrals to the Hospital. Based on this, it is alleged, the claims for the services the hospital provided to the referred patients were false claims, subject to recoupment by the government.
The Hospital’s Countersuit.
In an unusual strategy, the Hospital filed a counter-suit against the whistleblower, alleging that he breached his fiduciary duty to the Hospital and abused the legal process. The Hospital’s case asserts that instead of carrying out his duty to the Hospital, instead he capitalized on his alleged knowledge of the conduct to “extort a settlement” through a “false and frivolous” FCA suit as an act of revenge.
Additionally, the Hospital alleges that "at no time during his employment, or in his role as a partner at Deloitte, did he report any suspicions of fraud or violations of federal regulations to Wheeling Hospital's compliance officer."
You can read Wheeling Hospital's countersuit against the whistleblower on our website in full.
The Significance of This Case: Unique Defense Strategy for Defending a Whistleblower Suit.
This case shows a unique, but legally valid, defense strategy that might be used in other future whistleblower cases. Often the information about false claims is produced by high-ranking hospital or institutional employees whose job duties may have required them to report what they knew to the company as part of their job. The company should then have the opportunity to investigate and correct any improper billing or other misconduct that an errant employee might be carrying out on his own. By failing to do this, the employee may breach his duties to the company, may violate his employment contract, and may be subject to a suit or counter-suit over this. To the extent that the actions of the ex-employee causes the employer damages, the employer may be entitled to indemnification from the ex-employee.
However, the other side of the story is when an employee does make his or her superiors aware of suspected misconduct and false claims within the company and the company does nothing about it. This is often the case that we have when potential blowers contact us about filing a False Claims Act case. Often the whistleblower attempts to do the right thing by reporting it within the company and is stymied by his or her superiors. To us, this opens the door to legitimate whistleblower suits.
To read one of my prior blogs about South Florida Hospital reaching a settlement for similar FCA
claims, click here.
Click here to learn more about who can file a whistleblower/qui tam lawsuit and the reward programs for coming forward with a false claim.
Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.
Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistleblower or qui tam) case. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities that have been sued in False Claims Act (whistleblower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. 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.
Pearlman, Steve and Freeman, Meika. “Top 10 Whistleblowing And Retaliation Events Of The Year.” Law360. (December 20, 2019). Web.
Goldberg, Pinchos. “Hospital Sues Whistleblower for Failing to Report Information And Choosing Instead to Use As Basis for Claim.” JD Supra. (May 8, 2019). Web.
Commins, John. “HOSPITAL COUNTERSUES FALSE CLAIMS WHISTLEBLOWER.” Health Leaders. (May 9, 2019). Web.
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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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