SAN DIEGO — The El Centro Regional Medical Center in Imperial County, Calif., has agreed to pay the US government $2.2 million, plus interest, to settle allegations it defrauded Medicare, the Justice Department announced today.
The case was brought by a whistleblower, protected under federal law.
The government alleged that the 165-bed acute care hospital fraudulently inflated its charges to Medicare patients to obtain larger reimbursements from the federal health care program. The settlement covers claims submitted by the hospital for short inpatient admissions, usually of one day or less, when the services should have been billed on an outpatient "observation" basis or as emergency room visits.
"Hospitals that participate in the Medicare program must bill for their services accurately and honestly," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "We will take action to ensure that taxpayers do not pay the costs of health care providers’ fraudulent practices."
The lawsuit was brought under the qui tam — whistleblower — provisions of the False Claims Act, which allow private citizens to bring an action on behalf of the federal government and share in any recovery.
The whistleblower in this case, Pietro Ingrande, a former employee of El Centro Regional Medical Center, will receive $375,000 as his share of the recovery.
"Whistleblowers are critical to ensuring that Medicare dollars are not siphoned off, but find their way to those who most need them," said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the OIG-HHS. "Office of Inspector General special agents and our law enforcement partners have forged a powerful team that will work with private citizens who come forward to protect the Medicare Trust Fund and defend it from fraud and abuse."
The investigation was conducted by the Justice Department, US Attorney, the Office of Inspector General for the Department of Health and Human Services, and the FBI.
El Centro is a city in the Colorado Desert, an extension of the Sonoran Desert. It is about 100 miles east of San Diego.
"The Medicare system attempts to deliver much needed medical services to many Americans," said San Diego FBI Special Agent in Charge Keith Slotter. "Anyone who purposely defrauds the system, therefore, misappropriating its funds, and takes away resources from those who need Medicare’s services will be investigated by the FBI. We are committed to helping preserve the system’s integrity by vigorously pursuing those who attempt to steal the funds that help keep our fellow Americans in good health."
The case was part of a government initiative that has netted more than $4.4 billion recovered by allegedly Medicare and Medicaid defrauders.
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