Join, Follow & Connect
Join Modern Healthcare's LinkedIn group Follow Modern Healthcare on Twitter Join Modern Healthcare's Facebook group Follow Modern Healthcare's Pinterest board Modern Healthcare's Flickr page Modern Healthcare's YouTube Channel Get a Modern Healthcare news feed

 
Comment Buy Reprints Print Article Share on LinkedIn Share on Facebook Share on Twitter Email this page to a colleague
Healthcare Business News
 

Northwestern sued for allegedly double-billing feds for patient care


By Andrew L. Wang, Crain's Chicago Business
Posted: November 1, 2012 - 4:15 pm ET
Tags:

A former employee of Northwestern University has filed a whistleblower lawsuit against the university and Northwestern Memorial Hospital, alleging that the hospital improperly double-billed the federal government for patient care.

Audra Soulias, 36, alleges that the double billing, which concerns hospital patients who were participating in federally funded clinical trials, went on long before she started working for the university in 2007, and that she was laid off three years later after she repeatedly brought her concerns to supervisors.

The improper payments, she alleges, could total “hundreds of millions” of dollars.

“It's tax dollars,” she said in an interview. “That's the bottom line.”

Advertisement | View Media Kit

 

Ms. Soulias is the same woman who eight years ago sued Kennedy scion William Kennedy Smith, accusing him of sexually assaulting her at his home in 1999, on her 23rd birthday. At the time, she worked as a personal assistant to Dr. Smith, who was a physician and head of the Center for International Rehabilitation, an anti-landmine group in Chicago.

No criminal charges were ever filed in the case. Dr. Smith in 2004 denied the accusation, saying that he had a consensual relationship with Ms. Soulias for five months that year. She took legal action against him, he said, after he refused to pay her $3 million.

Ms. Soulias' suit against Dr. Smith was dismissed a year later. By that time, he had resigned as president and chairman of the landmine organization.

More than a decade earlier, Dr. Smith was cleared of charges he raped a woman at his family's compound in West Palm Beach. The televised trial took place in Florida in 1991. Dr. Smith's mother is Jean Kennedy Smith, and he is a nephew of former President John F. Kennedy. Dr. Smith currently is chairman and CEO of MedRed LLC, a Washington, D.C.-based health IT firm, according to the company's web site.

In the current case, Ms. Soulias said she started noticing irregularities after she joined Northwestern University as an employee working to administer research grants funded by the Bethesda, Md.-based National Institutes of Health.

She alleges that Northwestern Memorial patients covered by Medicare who were also participants in clinical trials were improperly classified so that the hospital's billing system failed to recognize those patients as research subjects. The hospital then often billed Medicare for the full cost of the patients' care.

Medicare rules specify that the program can cover only routine costs of care during a clinical trial plus any costs arising from complications due to trials, but not the costs of the trials themselves.

Despite the rules, Ms. Soulias said, the hospital sought reimbursement from grant funds for full trial costs.

“At the end of the year, we then would have paid the hospital for something they would have already received payment for” from Medicare, she said.

The lawsuit alleges that the defendants violated the federal False Claims Act. The suit calls for court to enter judgment against the defendants “in an amount three times the amount of damages the United States has sustained because of Defendants' actions” plus civil penalties totaling $16,500 for each violation.

Ms. Soulias is asking for a portion of damages in accordance with federal whistleblower statutes.

The suit was originally filed in November 2010 but remained under seal until July, when the U.S. Attorney's office in Chicago declined to join the case and seek damages on behalf of the government. A U.S. Attorney spokesman declined to give the reason for the decision.

A spokeswoman for Northwestern Memorial Health Care, which includes the hospital, said the health system's attorneys only recently received a copy of the suit and could not comment on it.

“We are currently reviewing it,” she said in an e-mail message.

Northwestern University said in a statement that its lawyers had not been served with the suit.

“However, it appears to center on the issue of Medicare billing, which Northwestern University is not involved in. Northwestern University does not bill Medicare. Therefore the University does not seem to be a proper party to the lawsuit and should be dismissed from the lawsuit.”

The case is next due in court before U.S. District Judge Elaine E. Bucklo on Dec. 12.


What do you think?

Share your opinion. Send a letter to the Editor or Post a comment below.

Post a comment

Loading Comments Loading comments...

Search ModernHealthcare.com:


 

Switch to the new Modern Healthcare Daily News app

For the best experience of ModernHealthcare.com on your iPad, switch to the new Modern Healthcare app — it's optimized for your device but there is no need to download.