Posts Tagged ‘Shands Hospitals’

Shands Hospitals Pay $3.25 Million in 2nd Part of Florida Whistleblower Settlement

Shands Health Care System has agreed to pay $3.25 million to settle outstanding claims that six of its Florida hospitals submitted improper outpatient billing to the government which resulted in overpayments from Medicaid, Medicare and TRICARE.   This settlement comes on the heels of a $26 million settlement in August of 2013, which resolved additional claims by the same whistleblower also related to improper patient admissions.

James Hoyer Law Firm Partner Christopher Casper served as co-counsel for whistleblower Terry Myers, along with Attorney Marlan Wilbanks, of the Wilbanks and Bridges Law Firm.

Mr. Myers filed the suit in the Middle District of Florida in April of 2008, naming Shands Health Care System and six of its Florida Hospitals:  Shands Alachua General Hospital; Shands Jacksonville Medical Center, Inc.; Shands Teaching Hospital and Clinics, Inc., d/b/a Shands at the University of Florida; Shands at Lakeshore, Inc.; Shands Live Oak; and Shands Starke.

In regards to the remaining allegations following the $26 million settlement, Myers contended that Shands knowingly submitted observation claims to Medicare, Medicaid and TRICARE for certain services and procedures which Shands knew or should have known that physician orders were missing or otherwise deficient for the charges billed.

Myers is the founder and President of YPRO Corporation. The company is a nationwide healthcare consulting firm that was hired by Shands in 2006 and 2007 to conduct audits to determine if Medicare and Medicaid rules were being followed.  Serious billing, coding, and compliance issues were uncovered by the whistleblower’s company and relayed to Shands Corporate Executives and Shands Compliance officers.  Mr. Myers felt compelled to take action by filing the whistleblower suit after Shands failed to correct the problems and self-report the overpayments to the government.

To settle the out-patient/observation claims, Shands will pay the United States $3.14 million for the federal portion of the settlement and an additional $103,668 to the State of Florida for the state portion of the settlement.

The lawsuit was filed under the federal False Claims Act (FCA) and the Florida False Claims Act. The False Claims Act allows private citizens to bring civil actions on behalf of the government in order to recover taxpayer money when fraud is suspected.   If a case is successful, the whistleblower is entitled by law to recover money from the Defendants.


Shands Hospitals Pay $26 Million in Florida Whistleblower Case

The Department of Justice announced today that Shands Hospitals will pay $26 million to settle charges of over-billing to Medicaid/Medicare for inpatient care.  The whistleblower case was filed under the federal False Claims Act and the Florida False Claims Act.  It was unsealed today upon announcement of the settlement.

Attorney Chris Casper of the James Hoyer Law Firm served as co-counsel, along with lead attorney Marlan Wilbanks, for whistleblower Terry Myers.  Meyers is the president of a healthcare consulting firm called YPRO Corp, which conducted financial audits for Shands.

According to the Complaint, in 2006 and 2007, Shands hired Mr. Myers and his company to audit six of its hospitals to determine if Medicare and Medicaid rules were being followed. They were specifically hired to see if Shands’ patients met the necessary requirements set by Medicare and Medicaid before being billed for inpatient services at six different Shands hospitals– Shands Alachua General Hospital, Shands Jacksonville Medical Center, Shands at the University of Florida, Shands at Lakeshore, Shands at Live Oak and Shands at Stark Hospitals.

Serious billing, coding and compliance issues were uncovered by the whistleblower’s company. The overall YPRO results showed that a significant percentage of all of the Medicare and Medicaid patient records audited should not have been admitted to the hospital as inpatients. Hospitalizations are much more expensive to the Government than outpatient services. Accordingly, Shands had a financial incentive to increase hospital admissions because they can charge higher rates than they can charge for outpatient treatments.

Despite recommendations by YPRO to Shands for the hospital to self-report the findings to the government, Shands did not disclose the findings of the audits and continued many of the practices that Mr. Myers believed to be fraudulent and illegal.  That lack of action ultimately led the whistleblower to file suit on behalf of the government, under the False Claims Act, to recover taxpayer money he believed was fraudulently obtained by the company.

The $26 million represents only a partial settlement of the charges in the Complaint. The Government has not yet completed its investigation of Mr. Myer’s allegations regarding outpatient claims.  Litigation regarding those charges will continue.

As allowed under the False Claims Act, Mr. Meyers will be awarded a portion of the settlement for successfully bringing the case to light.