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New Jersey hospital to pay $6.35 million to settle false claims allegations of inflating charges to obtain higher medicare reimbursement

Philadelphia: Robert Wood Johnson University Hospital Hamilton, a New Jersey-based hospital, has agreed to pay $6.35 Million to settle a whistleblower lawsuit alleging that the hospital defrauded Medicare. The whistleblower lawsuit filed against the Hamilton, NJ facility alleged that the hospital fraudulently inflated its charges to Medicare patients to obtain larger reimbursements from the federal health care program.

The qui tam whistleblower in one of the two lawsuits was represented by Marc S. Raspanti and Michael A. Morse, of the national whistleblower law firm of Pietragallo Gordon Alfano Bosick & Raspanti, LLP.

In addition to its standard payment system, Medicare provides supplemental reimbursement, called “outlier payments,” to hospitals and other healthcare providers in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payments system to ensure that hospitals have the incentive to treat inpatients whose care requires unusually high costs.

The whistleblower lawsuits against Robert Wood Johnson University Hospital Hamilton alleged that the hospital inflated its charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid. The United States Department of Justice intervened in both lawsuits in January 2008.

Attorney Marc S. Raspanti praised the courageousness of the qui tam whistleblowers in stepping forward and uncovering this substantial scheme to defraud the Medicare program. Raspanti added: “This case demonstrates the critical role that qui tam whistleblowers play in exposing fraud against taxpayers, like the abuse of Medicare outlier payments that occurred here.”

Attorney Michael A. Morse also credited the successful resolution of the case to the strong partnership between the Relators and the federal prosecutors, including United States Attorney Paul J. Fishman and Assistant United States Attorney Anthony LaBruna, as well as Daniel A. Spiro, Allison Cendali, and Jennifer Chorpening, trial attorneys with the United States Department of Justice Civil Division. Morse also praised the contributions of the Department of Health and Human Services Office of Inspector General and Centers for Medicare and Medicaid Services, and the Federal Bureau of Investigation.

The qui tam case is titled United States ex rel. James Monahan v. Robert Wood Johnson University Hospital at Hamilton, Case No. 02-5702 (JAG) (D.N.J.).

The False Claims Act allows private persons (known as “relators”) to file a lawsuit against those individuals, businesses, and other entities that have directly or indirectly defrauded the federal government. Although the federal government can file its own False Claims Act lawsuit, the true success of the statute has come in cases that were filed by whistleblowers.

Pietragallo Gordon Alfano Bosick & Raspanti, LLP is one of the largest and most successful whistleblower law firms in the United States. Lawyers in the nationwide qui tam whistleblower practice of Pietragallo Gordon Alfano Bosick & Raspanti have represented whistleblowers in cases that have recovered more than $1 Billion for federal and state taxpayers. For more information about the False Claims Act, qui tam lawsuits, or the nationwide whistleblower practice of Pietragallo Gordon Alfano Bosick & Raspanti, visit www.falseclaimsact.com; www.pietragallo.com; or www.fraudwhistleblowersblog.com.

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The lawyers in the national qui tam whistleblower practice of Pietragallo Gordon Alfano Bosick & Raspanti have proven, battle tested experience fighting for whistleblowers in federal and state false claims cases. The whistleblower practice group includes five former federal and state prosecutors who have:

  • Recovered over $1.8 billion for federal and state taxpayers
  • More than 30 years combined experience representing whistleblowers
  • Fought some of the most complex cases brought under federal and state false claims acts
  • Litigated against some of the largest companies in the United States
  • Represented whistleblowers in federal and state courts across the United States

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