U.S. Attorney’s Office Encourages Whistleblowers to Step Forward in Medicare Misconduct Case

Hospital building

Weirton Medical Center, a hospital in West Virginia, will pay $1.5 million to resolve allegations of False Claims Act violations. In the Department of Justice’s (DOJ) press release, U.S. Attorney William Ihlenfeld for the Northern District of West Virginia encouraged whistleblowers to come forward.

The hospital made a “voluntary self-disclosure” about potential violations of the Stark Law, which “prohibits a hospital from billing Medicare for certain services referred by physicians with whom the hospital has a financial relationship, unless that relationship satisfies one of the law’s statutory or regulatory exemptions,” the press release states. Weirton Medical Center allegedly “knowingly submitt[ed] or caus[ed] the submission of claims to Medicare in violation” of the Stark Law.

“The settlement resolves Weirton Medical Center’s liability under the False Claims Act for submitting claims to Medicare that resulted from violations of the Stark Law due to payment of compensation to referring physicians that allegedly exceeded fair market value or took into account the volume or value of the physicians’ referrals to the hospital,” the press release states.

“Health care decisions should be based on patients’ medical needs, not physicians’ financial interests,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the DOJ’s Civil Division. “The department will continue to investigate financial relationships that may improperly influence physician decision-making.”

U.S. Attorney Ihlenfeld said in the press release, “Improper compensation arrangements between hospitals and physicians will not be tolerated.” He also urged whistleblowers to come forward: “The U.S. Attorney’s Office will be aggressive in its pursuit of those who violate the Stark Law and we strongly encourage whistleblowers to come forward.”

Healthcare Whistleblowers

The qui tam provisions of the False Claims Act enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery, if one occurs.

Whistleblowers are key to uncovering fraud and corruption in the healthcare industry: fraudulent schemes can be particularly harmful to patients and erode trust in the medical system. In Fiscal Year 2021, qui tam whistleblowers helped the DOJ recover $1.6 billion in settlements. The DOJ highlighted health care fraud as “the leading source of the department’s False Claims Act settlements and judgments.”

Read the DOJ press release here.

Read more False Claims Act/qui tam news on WNN.

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