Shands: Paying the bill for false claims – $26 million

The Office of the United States Attorney for the Middle District of Florida has reported to Historic City News that one of the largest networks of health care providers in Florida will pay the government, and the state, a total of $26 million to settle allegations that six of its health care facilities submitted false claims to Medicare, Medicaid and other federal health care programs.

Confirmed in an announcement from the Department of Justice today, the three area entities, Shands Jacksonville Medical Center Inc., Shands Jacksonville Healthcare Inc., and Shands Teaching Hospital and Clinics Inc., and five additional Shands properties, were included in the settlement. Shands at the University of Florida; Shands Alachua General Hospital; Shands at Lakeshore; Shands Starke, and Shands Live Oak, were all part of the settlement.

“The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire of health care providers to maximize profits,” said Stuart F. Delery, Assistant Attorney General for the Civil Division. “Hospitals participating in Medicare must bill for their services accurately and honestly.”

Allegedly, from 2003 through 2008, the six hospitals knowingly submitted inpatient claims to Medicare, Medicaid and TRICARE for certain services and procedures that Shands Healthcare knew were correctly billable only as outpatient services or procedures.

“The public expects its medical professionals to operate with a high degree of integrity,” said A. Lee Bentley III, Acting U.S. Attorney for the Middle District of Florida in Tampa. “When health care providers seek higher profits at the expense of their professional judgment, the public trust in the medical system is compromised.”

The six Florida hospitals were named as defendants in a whistleblower lawsuit brought under the False Claims Act — which permits private citizens to sue on behalf of the government, and receive a portion of the proceeds of any settlement or judgment awarded against a defendant.

The lawsuit was filed in federal district court in Jacksonville by Terry Myers, the president of a healthcare consulting firm, YPRO Corp. Of the $26 million settlement, $25,170,400 will go to Medicare and other federal health care payers. The settlement also resolved allegations under the Florida False Claims Act; the state of Florida will receive $829,600. Myers’ portion of these recoveries has yet to be determined.

“Regardless of the complexity of these schemes to siphon off crucial health care dollars, our law enforcement officials will work tirelessly to seek justice,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services.

The claims resolved by these settlements are allegations only, and there has been no determination of liability. The lawsuit is captioned United States of America and the State of Florida ex rel. Terry L. Myers v. Shands Healthcare et al., Civil Action No. 3:08-cv-441-J-16HTS (M.D. Fla.).