Watts Law Firm PC recently settled a federal and state whistleblower case that required the defendant, Brattleboro Memorial Hospital (“BMH”), to pay $1.7 million to resolve the civil claim that BMH violated the federal and state False Claims Acts. Our suit alleged that BMH knowingly presented or caused to be presented false claims for payments to Medicare and Medicaid.

BMH is a Vermont-incorporated hospital engaged in providing medical services, procedures, treatments and prescriptions to the public and submitting claims for such services, procedures, treatments and prescriptions to Medicare, Medicaid and third-parties for reimbursement.

We brought the suit on behalf of Amy Beth Mean who had been BMH’s administrative employee with responsibilities for its financial services. Ms. Mean is an experienced hospital administrator with a Masters of Business Administration in Healthcare Management, a Bachelor of Arts with concentration in Health Systems Management.

The suit was filed under the qui tam provisions of the federal and state statutes. The U. S. Attorney for Vermont and the Vermont Attorney General intervened in the action. After an extensive investigation the agencies resolved the case. The government contended that from approximately January 2012 through September 2014 BMH knowingly submitted or caused to be submitted a number of outpatient laboratory claims lacking documentation necessary to support reimbursement by Medicare and Medicaid.

Ms. Mean managed daily operations of the BMH business office including admissions, billing, collection/cashiering and switchboard functions. She also established policies, procedures, standards and objectives for various departments.  She was responsible for hospital-wide telecommunications budged and operations.  She developed long-term accounts receivable strategies to maximize reimbursement, expedite cash flow and keep account t receivables at appropriate levels.  She shared responsibility for ensuring that hospital activities were consistent with its policies and governmental and third-party regulations for billing and collection practices.

While BMH employed Ms. Mean, she experienced, observed and protested BMH’s irregular, inaccurate, improper and illegal billings to the government health care funds for medical services, procedures and prescriptions.

Ms. Main worked in the finance department of the Brattleboro Memorial Hospital in Vermont. She detected inappropriate medical service charges to the government agencies. She reported them to the hospital. It ignored her complaints. It also made her on-the-job life miserable. She suffered considerable emotional distress but continued to urge the hospital to correct its practices. As part of the settlement, BMH was forced to pay $1.7 million in refunded charges to Medicare and Medicaid – and our client received a 15% reward for her courage in blowing the whistle.

The federal False Claims Act was enacted under President Abraham Lincoln during the Civil War to prevent arms suppliers and other manufacturers from cheating the government. The Act was strengthened in the 1990’s to provide greater rewards for employees who report their employers for cheating the government.

Recently, many states, including Vermont, enacted similar false claims act with the same rewards for employees reporting fraud against state governments.  The U. S. Justice Department reported recovering over $3.7 billion from false claims acts cases in 2017. $2.4 billion involved the health care industry, including drug manufacturers, hospitals, pharmacies, laboratories and physicians. Other industries caught in the false claims web included defense and national security programs and contracts relating to defense and national security, food safety and inspection, federally insured loans and mortgages, highway funds, small business contracts, agricultural subsidies, disaster assistance and import tariffs.

Watts Law Firm PC is pleased to consult with any Vermont employee who observes conduct that potentially financially cheats federal or state government to determine if a claim is appropriate.

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