St. Vincent Regional Medical Center in Santa Fe and its partner, Christus Health, agreed to pay $12.2 million to settle a whistleblower lawsuit. This involves false Medicaid payments and allegations that the hospital violated the False Claims Act. All of this was exposed because of a courageous whistleblower.
Healthcare Fraud Scheme
The fraud involves New Mexico’s Sole Community Provider Fund and Sole Community Provider Supplemental Payments programs. The organizations were supposedly making donations to St. Vincent Regional Medical Center. In order for the government to match funding, the hospital had to donate funds to those too poor to have medical insurance. These funds also help with hospital bills. The purpose of those programs is to use state and federal funds to help pay for the treatment. St. Vincent Regional Medical Center is the only hospital in the area.
Whistleblower Reveals Fraud
A whistleblower came forward to accuse the health organization of making illegal payments from 2001-2009. These illegal payments went to county governments and used to fund the state’s “matching” share of Medicaid payments to the hospital.
The “donations” resulted in false claims by the state of New Mexico to the federal government under the Medicaid program. So, the hospital and Christus gave their own money to the county of Santa Fe in return for receiving more money through hospital funding. The donations along with county dollars are matched 3-to-1 by the federal government. This happens because, in New Mexico, the state or local government must provide about $1 for every $3 the federal government pays.
Unfortunately, the brave whistleblower died last year. However, her estate will receive the whistleblower award of more than 18 percent of the government’s recovery. This is under the False Claims Act. This equals $2.4 million.
The Law Protects and Rewards a Whistleblower
When a knowledgeable attorney like those found in The Michael Brady Lynch Firm files a False Claims Act lawsuit, he or she files it under a seal. This means it is completely confidential. There is also a full disclosure statement in the suit, which details the evidence collected by a whistleblower.
After we file your suit, the Department of Justice will review the evidence before deciding to step in and decide if they want to prosecute the case. The government’s fraud investigator will work closely with you, the whistleblower to identify all responsible for the fraud.
You could be entitled to 15-30% of the funds recovered. In order to receive the reward, you must be the first one to file a case under the False Claims Act. This is why it is key to pick an experienced attorney to work quickly get your compensation.