Earlier this month, the University of Miami agreed to pay $22 million to resolve a lawsuit brought under the False Claims Act for fraudulent healthcare billing. Four former healthcare executives at the University of Miami filed the suit. The Department of Justice will award the whistleblowing executives a share of 15% to 25% of the $22 million.
According to the Justice Department, the University of Miami (UM) engaged in three types of fraudulent healthcare billing. First, UM improperly converted its physician offices into hospital facilities. Under Medicare regulations, providers can bill higher rates for services provided in hospital settings than physician offices. Medicare regulations require healthcare providers to notify patients of the higher rates. UM failed to do so, despite a Medicare contractor advising UM of its improper practices. Second, UM billed for unnecessary laboratory tests. Third, UM forced a local hospital to bill inflated claims or else UM surgeons would perform surgeries at another hospital.
Western Virginia is home to a number of universities. We know fraud has occurred at these universities. Perhaps most notably, a Roanoke federal jury found a Virginia Tech professor guilty of federal grant fraud, making false statements, obstruction, and sentenced him to two years in prison.
Whistleblowers often are executives, employees, colleagues, clients, or competitors of the offending healthcare provider. Individuals with knowledge that the fraud is occurring, such as university executives or senior nurses and assistants, can expose healthcare fraud. The whistleblower provisions of the False Claims Act protect whistleblowers from retaliation.
If you would like to report fraud, waste, or abuse, you can contact the attorneys at Frith & Ellerman.
 University of Miami to Pay $22 Million to Settle Claims Involving Medically Unnecessary Laboratory Tests and Fraudulent Billing Practices. U.S. Attorney’s Office. Press Release (May 10, 2021). Available at https://www.justice.gov/opa/pr/university-miami-pay-22-million-settle-claims-involving-medically-unnecessary-laboratory.
 Weaver, Jay. UM Agrees to Pay Millions to Settle Medicare Fraud Allegations Raised by Whistle-blower. Miami Herald (Nov. 6, 2020). Available at https://www.miamiherald.com/news/health-care/article246919602.html.
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 Former Virginia Tech Professor Sentenced for Grant Fraud, False Statements, Obstruction. U.S. Atty’s Office for the Western. District of Va. (Sept. 9, 2019) Available at https://www.justice.gov/usao-wdva/pr/former-virginia-tech-professor-sentenced-grant-fraud-false-statements-obstruction.