An ex-Northwestern University employee has submitted a whistleblower lawsuit against the institution and Northwestern Memorial Hospital claiming that they double-billed the federal government for patient care. The whistleblower, Audra Soulias, claims that the alleged Medicare fraud, involving hospital patients that were taking part in federally funded clinical trials, was going on even before she became employed by the university in 2007. She contends that she was laid off because she continued to voice her concerns about this practice to her supervisors.
Soulias, 36, believes that the allegedly improper billings could have cost the government “hundreds of millions” of dollars. She says that Medicare patients at the hospital that were also involved in clinical trials were improperly categorized so that the billing system wouldn’t identify them as research subjects. Northwestern would often then bill Medicare for the entire cost of the patients’ care, allowing the hospital to receive payment from Medicare for “something they would have already received payment for,” she said. (Medicare only generally covers routine care costs during a medical trial plus any expenses from related complications. Trial costs are not covered.)
Although Soulias filed her case alleging Medicare fraud in 2010, the case remained under seal until this summer. Her whistleblower complaint wants judgment against the defendants at three times the amount of losses the US sustained as a result of the alleged actions, civil penalties for the violations, and damages for Soulias.
Billing and Medicare Fraud
Billing is one way that Medicare/Medicaid Fraud is committed. Aside from double billing, other types of billing-related Medicare/Medicaid fraud may include:
- Billing for services not rendered, such as blood work, x-rays, or nursing services for a patient who has already checked out or died.
- Billing for patient visits that never actually happened.
- Billing for unnecessary services that a patient doesn’t really need
- Billing for more hours actually worked.
- Billing for a more costly version of a service than the one that was actually rendered.
- Billing for personal expenses and bundling them in with actual valid Medicare/Medicaid claims
The False Claims Act lets citizens act as whistleblowers to help the government expose fraud against it. Under the act, a whistleblower can be eligible to receive up to 30% of what the government obtains in the whistleblower award.
