OKLAHOMA CITY – The operator of an Oklahoma hospital has agreed to pay millions of dollars following allegations that the hospital participated in a ‘fraudulent billing scheme.’
Jennifferr Baird, who was a registered nurse at Oklahoma Heart Hospital, filed a complaint against the hospital under the federal False Claims Act. The FCA makes it illegal to deceive the federal government for financial gain.
“Jennifferr did her best to resist the administrators who pushed this fraudulent billing scheme,” said R. Scott Oswald, managing principal of The Employment Law Group. “And she urged everyone she managed to do the same. But when she realized she was fighting a losing battle—and that the true victims were U.S. taxpayers—she appealed to a higher power: The U.S. legal system, which welcomes whistleblowers like her. I am pleased that it delivered.”
According to Baird’s complaint, the Oklahoma Heart Hospital consistently billed the state’s Medicaid insurance program for stent procedures at inpatient rates, even if the procedure was handled on an outpatient basis.
“First, OHH routes almost all of its Medicaid patients to inpatient treatment when many should be classified as outpatient; in doing so OHH is able to charge significantly larger fees for the same treatment. The fraud is evidenced by the fact that OHH does not treat its Medicare or privately insured patients similarly. Second, OHH fraudulently manipulates its re-hospitalization rate of Medicare patients to induce the government to pay it a bonus,” the lawsuit alleged.
Federal and state prosecutors allege that the fraudulent billing practices lasted at least seven years.
Officials with the Oklahoma Heart Hospital never admitted to any fraudulent billing practices but agreed to pay $2.8 million to settle the claims.
“I’m hopeful that the culture at Oklahoma Heart Hospital now will change,” said Ms. Baird. “The frontline medical team has always been great, but I think some hospital officials cared more about dollar signs than vital signs.”