Last week the Atlanta Journal Constitution reported the case of Teri Ramsey, a former St. Joseph’s Hospital nurse turned whistleblower whose False Claims Act lawsuit against St. Joseph’s cost the hospital $26 million with a net reward to her of $4.9 million.This is the highest paid health care fraud in Georgia history.
Ramsey, a nurse by profession, was hired to review hospital admissions.Within weeks of beginning her job, Ramsey noticed that many outpatient services were billed as inpatient services.The billing distinction allowed for St. Joseph’s to collect significantly more from Medicare.Ramsey complained to supervisors and doctors, but claims she was quickly rebuffed and even told not to “rock the boat.”Ramsey’s persistence caused her to be ostracized by co-workers and intimidated by supervisors.The hospital culture created a disincentive to whistle blowing.
Ramsey persisted, nevertheless.She contacted an attorney and filed a complaint under the federal False Claims Act. This Act, also known as a qui tam proceeding, allows private citizens to sue on behalf of the United States for fraudulent claims on United States funds.The False Claims Act has considerable teeth. Defendants found liable under the Act must pay treble (three times) damages of the actual over billing.Also, the Act provides for civil penalties of $5000 per each fraudulent claim.Finally, in order to encourage private citizens to turn in defrauders, the private citizen is entitled to collect 15 to 25 percent of the recovery.Often, federal prosecutors step into the suit and pursue it on behalf of the government.
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