Baptist Health Systems Settles Federal False Claims Act Civil Lawsuit

Baptist Health Systems, one of the largest health care providers in San Antonio, has paid $3,675,000 to the United States Department of Justice to settle allegations that it violated the federal False Claims Act by filing false claims for reimbursement under the Medicare program United States Attorney Robert Pitman announced today. 

The federal investigation was triggered by allegations contained in a whistleblower lawsuit filed by Norma Rivera in United States District Court in San Antonio.  The lawsuit alleged that Baptist Health Systems improperly filed claims with the Medicare program by failing to disclose on the claim that the patient receiving treatment had another insurance policy that covered the care at Baptist.  The suit further alleged the Medicare program overpaid Baptist Health Systems on claims from 2003 through 2007.   Under the law, a health care provider is required to disclose the fact that a patient has other insurance when it files its claim with Medicare.  The claim is processed under the other insurance policy and, in most cases, Medicare pays whatever the patient was out of pocket (such as a deductible or copayment).   If the health care provider receives a double payment because the insurance company is slow to pay, then the health care provider must reimburse Medicare.

United States Attorney Pitman stressed that Baptist Health Systems cooperated with the investigation, including conducting an audit of claims going back to January 2003.  The audit was disclosed to the United States Attorney’s Office, allowing the government and Baptist to reach an acceptable settlement.  Assistant United States Attorney Harold E. Brown, Jr., from the Affirmative Civil Enforcement Unit investigated the case and negotiated the settlement.  

The False Claims Act provides that a whistleblower will receive a portion of the settlement for bringing the problem to the attention of the government.  In this case, Norma Rivera received $661,500 as her share of the settlement.  In addition to paying $3,675,000 to the Government, Baptist Health Systems paid Rivera’s attorneys’ fees and expenses.

Individuals who suspect Medicare fraud, waste or abuse are encouraged to report this information to the United States Department of Health and Human Services.  Information on how to make this report is online at http://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/report-fraud/reporting-fraud.html.  You can also report Medicare fraud by calling 1-800-MEDICARE.