Every once in a while, I ask myself why am I a False Claims Act lawyer. False Claims Act cases are difficult to win, partly because the government only intervenes in a small percentage of the qui tam cases filed, leaving the majority of cases to be litigated by the whistleblower and his or her attorney, without the real party in interest, the United States, being directly involved and active in the case. These non-intervened cases only account for about 4% of all False Claims Act recoveries.
But whenever I get a phone call, an email, or a referral from another lawyer for a whistleblower case, I still get excited about the prospect, the potential, for a meaningful False Claims Act case that will right a wrong, and bring a significant financial reward to my client.
Last week, the Justice Department announced that Saint Joseph Health System Inc, agreed to pay the United States $16.5 million. According to the government, doctors at St. Joseph were performing pacemaker surgeries, coronary artery bypass surgeries, and diagnostic catheterizations, all on patients who did not need these procedures, simply for financial gain. Here we are not talking about a doctor padding the bill, by billing for a 40 minute office visit when it only took 20 minutes, we are talking about doctors and a hospital knowingly, intentionally, performing invasive cardiac procedures just to make some more money with absolutely no thought or care for their patients’ well-being. This is why whistleblowers perform such an essential and necessary role in our efforts to uncover and stop fraud, waste, and abuse, and in this case real harm being done to patients.
The physicians performing these unnecessary procedures were part of the Cumberland physician group, which had an exclusive relationship with Saint Joseph Hospital to provide cardiology services. One of the doctors, Dr. Sandesh Patil, has pled guilty and was sentenced to 30 months in prison. According to government attorneys and agents, we all expect that our doctors will make medical decisions based on the best treatment options and not on what is in the best financial interest of the physician or hospital. These kinds of cases cause harm not just to the Medicare and Medicaid systems but also to the patients themselves.
This case was investigated by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which is a partnership between the Department of Justice and the Department of Health and Human Services, and focuses on Medicare and Medicaid fraud investigations and prevention. Since 2009, the DOJ has recovered over $17.1 billion under the False Claims Act, with $12.2 billion of that amount being recovered from cases involving fraud against a federal health care program, including Medicare and Medicaid.
This case is titled, United States ex rel Jones, et al., v. Saint Joseph Health System et al., 11-cv-81 (Eastern District of Kentucky).
For more information about False Claims Act cases, contact the Law Office of Michael Rosenblat.