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New York, US and whistleblower split Medicaid fraud settlement

Three New York hospitals have agreed to pay a $2.95 million settlement for charges of Medicaid fraud after violating the False Claims Acts. Mount Sinai Beth Israel, Mount Sinai St. Luke's and Mount Sinai Roosevelt hospitals along with their former venture Continuum Health Partners stood accused of failing to repay improper billings within the legally required 60 days. The inaccurate charges totaled over $844,000 from 444 claims between 2009 and 2010.

A whistleblower played a crucial role in bringing the situation to the attention of authorities. The man, who had been a technical director for operations at Continuum Health Partners, will receive 20 percent of the settlement. The remainder will be divided by New York State and the federal government.

The U.S. Attorney in Manhattan said that the whistleblower had informed the employer about a software glitch that was creating the false claims. Four days after urging senior management to acknowledge the problem, the man was dismissed. The health care company did not make repayments until March 2013. According to court papers, the hospitals have since acknowledged their responsibility for the late repayments.

When the federal government investigates white-collar crimes like this one, many people at an organization might be initially scrutinized. A person faced with this situation could find an attorney to provide legal advice. A lawyer could accompany a person during questioning and potentially guard against violations of the person's rights. If charges are filed against the client, then the attorney could develop defense strategies. The strength of the evidence could be weighed against the charges. Weaknesses could be challenged by the attorney, who might seek a dismissal of the case or reduced charges.

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