A nurse and a doctor were the whistle blowers here and worked in the ER room at a hospital in Philadelphia and at a medical center in Tennessee. The lawsuit was filed in 2011 and stated that routinely people were admitted who did not need to be there. This practice picked up additional dollars for the hospitals from both Medicare and Medicaid. BD
WASHINGTON, Aug 04, 2014 (BUSINESS WIRE) -- Community Health Systems, Inc. (CHS) has agreed to pay over $98 million to resolve allegations that it overbilled the federal Medicare and Medicaid systems by unnecessarily admitting patients to more than 100 of its hospitals across the country. The settlement was announced today by the U.S. Department of Justice.
Cohen Milstein Sellers & Toll PLLC, along with co-counsel Grant & Eisenhofer and Barrett, Johnson, Martin & Garrison, represented plaintiff-relators Dr. James Doghramji and Sheree Cook in their False Claims Act lawsuit against CHS, one of seven lawsuits resolved by today’s settlement. Dr. Doghramji has served as an emergency room physician at Philadelphia’s Chestnut Hill Hospital and Cook worked as a nurse at Heritage Medical Center in Shelbyville, Tenn. In May 2011, they filed United States ex rel. Doghramji v. Community Health Systems Inc. in the U.S. District Court in Nashville, Tenn. The complaint alleged that CHS routinely admitted patients whose conditions were not severe enough to justify admission, and then billed Medicare and Medicaid for those admissions.
In addition to specific allegations about CHS’ admission practices, Dr. Doghramji and Cook also provided a comprehensive statistical analysis showing admission rates that were significantly higher than expected at more than 70 CHS hospitals nationwide.
“CHS unnecessarily hospitalized patients so that it could make more money through larger Medicare and Medicaid reimbursements.