Christus Whistleblower Allegation Settles for Nearly One Million Dollars

Houston, Texas, based hospital chain Christus Health Systems, which runs facilities in several states including Utah, has settled a “qui tam” whistleblower suit for $970,987. The allegations claim that Christus billed Medicare for ineligible costs and expenses and failed to disclose overpayments by Medicare, both of which are considered Medicare fraud.

The qui tam claim was originally filed in 1998, and since that time, Medicare has recovered $62.9 million as a result of the suit.

Medicare Fraud: One Type of Federal Crime

According to the Medicare website, Medicare fraud results in millions of dollars being paid annually to individuals who are abusing, defrauding and cheating the program. But acts that might constitute fraud could be inadvertent as Medicare billing and reimbursement procedures can be complicated. Examples of Medicare fraud include:

  • Billing Medicare for services that were never received
  • Billing Medicare for services or equipment that are different from what was received
  • Using another’s Medicare care to receive care, supplies or equipment
  • Billing Medicare for equipment after the equipment has been returned

Those who can be charged with Medicare fraud range from large HMOs to a doctor in a small town, and charges can cross many different medical fields from dentists and doctors to pharmacies, pharmacists and others that provide medical services or equipment.

Qui Tam Claims

The Medicare fraud whistleblower settlement discussed above is a somewhat unique type of federal claim. Medicare fraud whistleblower allegations are considered to be “qui tam” actions, which is a provision of the Federal Civil False Claims Act. These actions allow, by statute, that a private person who blows the whistle on fraudulent activity is able to sue for a penalty for defrauding the government, some of which the government will receive if the suit is successful. Essentially, a qui tam action allows a private to citizen to bring and action on behalf of or in place of the government.

If you face Medicare fraud charges, you need a lawyer with experience defending against federal charges.

Related Story: Christus Settles Medicare Fraud Charges for Nearly $1M

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