San Antonio Healthcare
9:37 am
Tue November 19, 2013

Baptist Health System Settles $3.5 Million Federal False Claims Lawsuit

The U.S. Attorney in San Antonio has settled a $3,675,000 whistleblower lawsuit against the Baptist Health System for filing false claims for Medicare reimbursement.

According to the U.S. Attorney’s Office, the federal investigation under the False Claims Act was triggered by allegations in a whistleblower lawsuit brought by a former employee of the Baptist Health System.

Assistant U.S. Attorney Harold Brown said Norma Rivera reported she tried twice to bring the problem to the attention of her employers.

"Back in 2004, Ms. Rivera was working for Baptist," Brown said. "She pointed out to them that they were billing Medicare incorrectly. She then left their employment, came back in 2006, and found out they were still doing the same thing. She told them once again, and then went out, hired a lawyer and filed this lawsuit."

Brown said Baptist claimed Rivera did not bring the problem to authorities in 2004 as she stated and that when she pointed it out in 2006, they immediately implemented corrective action.

"This settlement resolves a qui tam (whistleblower) action alleging certain claims submitted to Medicare from 2003 to 2008 were submitted to Medicare without complete information about other payer sources," said Baptist spokesperson Ashley Cardenas.

Brown said Baptists settled the case for $3,675,000, avoiding litigation. He also said the company conducted audits of its accounts before reimbursing the government for the Medicare overpayments, and the government was satisfied that the company has implemented policy to prevent improper filing of claims in the future.

Under the whistleblower statute, Rivera will receive a portion of the settlement for filing the lawsuit plus reimbursement of her legal fees.