04/29/2013 // Whistleblower Law Firm // Keller Grover. LLP // (press release)
A Florida lawsuit — scheduled for trial this November — has become a vivid example of how whistleblowers can uncover fraud. The case, in the U.S. District Court in Orlando, alleges a decade’s worth of malfeasance by a major area hospital: Medicare and Medicaid fraud, unnecessary hospital admissions and surgeries, and illegal kickbacks to doctors. In all, damages may amount to more than $200 million. Brought by a hospital employee who claims to have observed the improper behavior, the lawsuit shows how a single individual — and the whistleblower laws that empower and protect them — can be an effective weapon in the fight against fraud.
Elin Baklid-Kunz, who has worked in compliance and revenue services for Halifax Hospital Medical Center in Florida, told the Orlando Sentinel this month that she “kept hoping someone else would do it, but sometimes you have to be that someone.” If Baklid-Kunz’s allegations are borne out at trial, the lawsuit — which has been joined by the federal government — could potentially become the largest whistleblower case of its kind in U.S. history.
“Whistleblowers like Ms. Baklid-Kunz are an essential element of fighting fraud and we need more of them especially in hospitals where there is potential for real patient harm,” says Jeffrey F. Keller, a veteran whistleblower lawyer at Keller Grover, a labor and employment law firm that is not involved in the Halifax Hospital case. “They are insiders who have seen the improper behavior first hand and can alert us to it, which is the first step in rectifying it.
Federal and state whistleblower laws help immeasurably, says Keller, as “they not only enable these important suits, but protect whistleblowers and also give them a share in any ultimate recovery — a powerful incentive to speak up.”
In recent years, whistleblower laws have proven remarkably successful. The gold standard of these statutes — the federal False Claims Act — has led to the recovery of more than $30 billion stemming from fraud against the government since it was significantly modified in the mid-1980s.
“The False Claims Act is rapidly becoming one of our most potent tools in the crackdown on Medicaid and Medicare fraud,” says Keller, whose firm has offices in Los Angeles and San Francisco. “These government programs are all too often targets for wrongful behavior, including improper billing and inappropriate admissions. The allegations in the Halifax case are not unique to Florida. We see them — and see them increasing — all over the country.”
The Halifax suit alleges that between 2000 and 2011, the hospital — a 764-bed facility in Daytona Beach — admitted thousands of patients whose medical circumstances did not warrant it. This alone, the lawsuit contends, resulted in more than $30 million in fraudulent billings to Medicare and other payers. Included in the complaint are the results of several internal audits conducted by the hospital — one of which found that during one month in 2008, 82 percent of patients admitted for chest pains did not meet the criteria for admission.
Discovering what she believed was a pattern of overbilling and other improper acts, Baklid-Kunz alerted her supervisor. “I was told, my loyalty has to be to the hospital, not the government,” she told the Sentinel.
“She didn’t see it that way,” says Keller. “And for that, we all should be grateful. Now we need more brave whistleblowers to come forward, and help us stamp out more fraud like this.”
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