Whistleblower, Kreindler & Associates Help Government Recover $15.5 Million from Harris County Hospital District for False Medicare/Medicaid Claims.
Settlement Agreement is Among Largest in Southern District of Texas
HOUSTON -- Because of a Harris County Hospital District The Harris County Hospital District is a governmental entity with taxing authority that owns and operates three hospitals and numerous clinics throughout Harris County, Texas, including the city of Houston. employee's persistence in challenging improperly filed health insurance claims, the federal Medicare and Medicaid Medicare and Medicaid
U.S. government programs in effect since 1966. Medicare covers most people 65 or older and those with long-term disabilities. Part A, a hospital insurance plan, also pays for home health visits and hospice care. programs will recover almost $15.5 million from the hospital district, according to the settlement agreement unsealed today by the U.S. District Court for the Southern District of Texas. The matter, filed under seal in federal court since October 2003, was filed under the powerful, but little known, whistleblower whis·tle·blow·er or whis·tle-blow·er or whistle blower
One who reveals wrongdoing within an organization to the public or to those in positions of authority: "The Pentagon's most famous whistleblower is . . provisions of the federal False Claims Act and Texas Medicaid Fraud Medicaid fraud The fraudulent billing of Medicaid by physicians or other health care providers, especially international medical graduates and psychiatrists. See Medicaid. Prevention law. The case is styled United States ex rel ex rel. conj. abbreviation for Latin ex relatione, meaning "upon being related" or "upon information," used in the title of a legal proceeding filed by a state attorney general (or the federal Department of Justice) on behalf of the government, on the instigation of . Robert E. McCaslin, Jr. v. Harris County Hospital District; No. H-03-4438.
Attorney Mitch Kreindler of Kreindler & Associates in Houston and co-counsel Matt Smith of Phillips & Cohen cohen
(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. L.L.P., of Washington, D.C., represented the whistleblower, Robert McCaslin, during the legal proceedings All actions that are authorized or sanctioned by law and instituted in a court or a tribunal for the acquisition of rights or the enforcement of remedies. in which the Harris County Hospital District (HCHD HCHD Harris County Hospital District
HCHD Hillsborough County Health Department (Florida)
HCHD Huron County Health Department (Michigan) ) ultimately agreed to reimburse the federal and Texas state governments for improperly filed health insurance claims during a period of six years, from 2000 to 2005. Based on its investigation, the government estimates that incorrect claims were filed on behalf of thousands of patients.
The $15,449,126.97 settlement is among the largest cases settled in the Southern District of Texas under the False Claims Act. Cases filed under the False Claims Act in fiscal year 2006 yielded more than $3.166 billion in reimbursement to the federal government, according to statistics maintained by the Department of Justice.
A patient account representative in the Patient Business Services Division at HCHD since April 2001, McCaslin first suspected a systemic problem in the way HCHD was submitting Medicare claims in May 2003. Upon reporting the discrepancy to several supervisors and compliance personnel, McCaslin observed that the erroneous claims continued. He then anonymously notified HCHD's Medicare fiscal intermediary fiscal intermediary Part A Contractor Medicare A private company that has a contract with Medicare to pay part A and some part B bills. See Medicare, Part A. , Trailblazer Health Enterprises LLC (Logical Link Control) See "LANs" under data link protocol.
LLC - Logical Link Control , of a specific fraudulent claim. He saw that Trailblazer required HCHD to correct the claim. Secure in the knowledge that he was right, McCaslin sought outside legal assistance to pursue the matter under the provisions of the False Claims Act.
"The way this settlement evolved is a textbook example of how the False Claims Act should work. Thanks to the honesty and courage of Mr. McCaslin, taxpayers have been reimbursed, and the Hospital District has corrected process errors and made necessary staffing changes," Kreindler explained. "The whistleblower, Mr. McCaslin, recognized the wrongdoing wrong·do·er
One who does wrong, especially morally or ethically.
wrongdo and called it to the attention of his supervisors. When his complaints fell on deaf ears, Mr. McCaslin continued to fight for what he knew was right. He enlisted the help of legal counsel, and we alerted the appropriate government entities, who launched an investigation. The False Claims Act empowers individuals to fight those who would defraud the government. To the Hospital District's credit, it was close to a model citizen once it recognized that it had a significant problem."
HCHD engaged in two separate activities that are covered by the settlement. First, HCHD charged Medicaid for medical care provided to individuals who were in the custody of law enforcement officials. Under the existing law, Medicare and Medicaid will not pay such expenses.
Second, HCHD failed to comply with the Medicare as Secondary Payer (MSP (1) (Management Service Provider or Managed Service Provider) An organization that manages a customer's computer systems and networks which are either located on the customer's premises or at a third-party datacenter. ) law. Under the law, health care providers are required to seek payment from insurance coverage that is primary to Medicare and Medicaid. Of the thousands of inaccurate claims involved, the majority of improperly filed claims involved patients who had been injured in motor vehicle accidents and treated at HCHD facilities, such as Ben Taub Hospital. Despite knowing that other insurance existed in most motor vehicle accident cases, HCHD billed the individual's medical treatment directly to Medicare. "With these claims involving car accident victims, HCHD simply bypassed submitting the claims to the primary insurance policy even when a primary insurer existed and the contact information for the insurer and its insured was already known to HCHD," Kreindler explained.
McCaslin's case was formally filed in October 2003 under the False Claims Act and its qui tam QUI TAM, remedies. Who as well. When a statute imposes a penalty, for the doing or not doing an act, and gives that penalty in part to whosoever will sue for the same, and the other part to the commonwealth, or some charitable, literary, or other institution, and makes it recoverable by provisions. Qui tam allows any person with evidence of fraud against federal programs or contracts to sue the wrongdoer on behalf of the government. The act provides for the whistleblower, or relator The individual in whose name a legal action is brought by a state; the individual who relates the facts on which an action is based.
The relator is the individual upon whose complaint certain writs are issued. , to receive between 15 and 25 percent of the amount recovered by the government. Under this provision, the federal government will pay $2,780,842.85 of the settlement - or about 18 percent - to McCaslin for his assistance in recovering these funds.
Kreindler & Associates was founded in November 2000 and is dedicated solely to the representation of False Claims Act whistleblowers. The firm provides an uncommon degree of client service and support to whistleblowers that have made the difficult decision to do what is right, often with significant personal hardship. With a practice that is national in scope, Kreindler's offices are located in Houston and the Philadelphia area.
For more information about Kreindler & Associates and the whistleblower provisions of the False Claims Act, visit www.blowthewhistle.com.
Note to media: Copies of the settlement and original complaint are available upon request.