Florida Heath Company Will Pay $20 Million To Resolve False Claims Act Claim

On April 6th, 2022, the Department of Justice (DOJ) announced that BayCare Health System Inc.—a nonprofit health care organization based in Tampa, Florida—will pay $20 million to settle a False Claims Act case. Several hospitals affiliated with BayCare Health System Inc. were also cited as part of the enforcement action. In this article, our Florida healthcare billing fraud attorneys discuss the announcement by the DOJ and whistleblower rights under the False Claims Act more generally.

False Claims Act Allegations: Improper Claim for Matching Funds 

Florida’s Medicaid program provides health care services for low income individuals and families in the state. As with other Medicaid programs, Florida Medicaid is funded by a combination of state and federal dollars. The DOJ alleges that between the fall of 2013 and the fall of 2015, BayCare Health System Inc. and four affiliated hospitals knowingly made improper claims for matching federal funds for certain health services.

More specifically, the federal government contends that BayCare Health made improper donations to an entity called the Juvenile Welfare Board of Pinellas County. That local entity then transferred funds to the State of Florida, triggering matching federal funds being sent directly to BayCare Health. Notably, the State of Florida used the money it received to cover services at BayCare Health and the affiliated hospitals. In effect, the nonprofit healthcare organization received its initial donation back and also received improper matching funds from the federal government.

A Whistleblower Was Granted $5 Million for Contributions Made in Stopping the Fraud 

Healthcare billing is notoriously complex. Unfortunately, improper billing practices remain a serious problem in the industry. It is often insider employees and other people with non-public information who help to bring a stop to medical billing fraud. In this case, the False Claims Act action taken against BayCare Health System Inc. was initiated by an individual named Larry Bomar. Mr. Bomar previously served as the reimbursement manager at one of the hospitals cited in this case.

Mr. Bomar filed a qui tam lawsuit under the False Claims Act alleging billing fraud by BayCare Health System Inc. and the hospitals. Through a qui tam claim, any individual, including an employee, can step into the role of the federal government and take action to stop fraud. When a qui tam claim is successful, the whistleblower can receive a significant portion of the funds recovered by the government. In this case, Mr. Bomar received $5 million in whistleblower compensation for initiating the False Claims Act lawsuit.

Seek Help From a False Claims Act Attorney in Florida

At Guttman, Freidin & Celler, we are relentless, aggressive advocates for justice. With extensive experience handling healthcare billing fraud and hospital billing fraud claims, our False Claims Act lawyers know how to protect the rights of whistleblowers. Call us now or contact us online for a free and strictly confidential initial consultation. From our legal office in Miami, we handle federal False Claims Act cases and Florida False Claims Act cases.

Resource:

justice.gov/opa/pr/florida-s-baycare-health-system-and-hospital-affiliates-agree-pay-20-million-settle-false