Posts Tagged ‘whistleblower suit’

Federal Government Joins Prime Healthcare Whistleblower Suit


Prime Healthcare Whistleblower Karin Berntsen

The federal government is joining the whistleblower case of James Hoyer client Karin Berntsen against Prime Healthcare Services, its founder Dr. Prem Reddy, and more than a dozen of its hospitals.  Prime is a fast growing company that owns more than 40 hospitals nationwide.

The whistleblower suit, which was unsealed in December of 2013, alleges Prime improperly admitted patients through its emergency rooms to increase payments from Medicare.

James Hoyer partner Elaine Stromgren called the government’s intervention “a significant development which shows the seriousness of the allegations and the strength of the evidence supporting those claims.”

The Department of Justice news release explains some of the key allegations:

The lawsuit alleges that Dr. Reddy directed the corporate practice of pressuring Prime’s Emergency Department physicians and hospital administrators to raise inpatient admission rates, regardless of whether it was medically necessary to admit the patients.  The lawsuit alleges that Prime’s corporate officers, at Reddy’s direction, exerted immense pressure on doctors in the Emergency Departments to admit patients who could have been placed in observation, treated as outpatients or discharged.  As a result of these medically unnecessary admissions from the Emergency Departments, Prime hospitals allegedly submitted false claims to federal health care programs, such as Medicare.

Whistleblower Karin Berntsen remains in her position at Alvarado Hospital in San Diego as Director of Performance Improvement.  She came forward to expose these practices because she believes they put  patients at risk in order to increase profit.

DOJ says the government’s intervention in this case shows its emphasis on combating health care fraud:

“The Department of Justice is committed to ensuring that health care providers do not inappropriately seek to profit at the expense of federal health care programs,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.  “Schemes such as this one can contribute significantly to the rising cost of health care delivery and create needless patient risk.”

“Fraudulent billing practices, such as those alleged in this civil lawsuit, harm taxpayers who fund health care programs, such as Medicare,” said U.S. Attorney Eileen M. Decker for the Central District of California.  “The Justice Department works collaboratively with law enforcement agencies, regulators and, in some cases, private citizens to ensure the integrity of a system that provides healthcare to millions of Americans.”

“Charging for medically unnecessary services, as alleged in this case, raises costs in government health programs and remorselessly passes that bill along to taxpayers,” said Special Agent in Charge Christian J. Schrank of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).  “Our investigation into the allegations in this case, along with our law enforcement partners, led to the government’s decision to intervene.”

Contact Us ButtonThe whistleblower suit also alleges that Prime would “upcode” patient diagnoses to make them appear more serious, in order to get additional Medicare payments.  The James Hoyer firm will continue to vigorously pursue this count as well.

Multiple news outlets reported on the significant development, including the Center for Investigative Reporting, Wall Street Journal, Los Angeles Times, San Diego Union TribuneModern Healthcare, and Becker’s Hospital Review, among others.


Al Jazeera America Profiles Whistleblower Case Alleging Babies Endangered for Profit

James Hoyer Whistleblower Attorneys Represent Dr. Judy RobinsonDr. Judy Robinson, represented by James Hoyer whistleblower attorneys, filed a qui tam case that was the subject of an in-depth story on Al Jazeera America’s flagship news program America Tonight.  Dr. Robinson’s suit alleges poor, pregnant women and their newborn babies were put at risk in a fraud scheme designed to increase profit for Indiana’s largest healthcare system. Dr. Robinson’s suit alleges IU Health and HealthNet used midwives to care for high risk patients to save money.

Correspondent Lori Jane Gliha profiled high risk patients who suffered harm after getting the majority of care from midwives, instead of doctors.  Indiana Medicaid rules require that doctors handle the care of high risk, low income, pregnant mothers, not midwives, because complications can arise quickly and put mother and baby in danger. The video below is an excerpt from Gliha’s report.



Family Reacts to Whistleblower Suit against IU Health


Dr. Judith Robinson

The NBC affiliate in Indianapolis continued its coverage of a whistleblower case filed by James Hoyer law firm client Dr. Judith Robinson.  In a powerful report, WTHR TV Investigative Reporter Sandra Chapman interviewed the mother of a maternity patient who died during childbirth at Methodist Hospital in Indianapolis.

Dr. Robinson is a well-respected Obstetrician/Gynecologist who’s practiced in Indianapolis for 30 years. She chose to come forward as a whistleblower and put her career on the line after witnessing multiple violations of Medicaid rules, which she believes put pregnant women and their babies at risk.

Both WTHR and the Indianapolis Star told the story of Dr. Robinson’s whistleblower case in earlier reports.

Watch the video below to see WTHR’s latest story: “Mom dies during childbirth; Family reacts to $100M suit against IU Health.”

13 WTHR Indianapolis


EDMC Whistleblower Case Moves Forward

The whistleblower case filed against Education Management Corporation by James Hoyer Law Firm client Jason Sobek has cleared a major hurdle. U.S. District Court Judge Terrence McVerry in Pittsburgh ruled to deny EDMC’s Motion to Dismiss Sobek’s suit.  The case will proceed on three major counts involving misrepresentations of job placement statistics and accreditation and allegations that EDMC failed to adequately record the Satisfactory Academic Progress of students, whereby allowing its schools to collect federal financial aid to which they were not entitled.

Sobek filed the suit in 2010 against EDMC, the country’s second largest for-profit college provider, after witnessing questionable practices while working as an Admissions Representative at the company.

Oral arguments were presented before Judge McVerry in Pittsburgh on May 13, 2013 by James Hoyer Senior Partner Christopher Casper. In response to today’s ruling, Casper said, “We are encouraged by the Court’s ruling.  It sends a message that companies cannot rake in hundreds of millions of dollars in taxpayer money while blatantly violating federal law.”

In his ruling denying EDMC’s Motion to Dismiss,  the judge wrote “EDMC presents several overarching lines of reasoning in support of dismissal.”  One of EDMC’s arguments claimed that even if the company committed the alleged violations, it would not be grounds for the government to refuse paying its schools federal financial aid.  The judge indicated “such a defense is fact-intensive and would not justify dismissal at the pleading stage.”  As a result, Judge McVerry determined “a final determination is premature at this time” and the case should proceed.

The case will now move on to the discovery phase.  “We look forward to taking depositions and the opportunity to put EDMC under oath,”said Casper.

Three additional counts in the suit were voluntarily dismissed.  One of those regarding “incentive compensation” continues on in a separate whistleblower case filed against EDMC.