A nurse will get nearly $5 million from a whistle-blower lawsuit she filed against her former employer, St. Joseph’s Hospital of Atlanta, which has agreed to pay $26 million to settle the allegations.
The 382-bed hospital allegedly billed the government for inpatient admissions although the visits were outpatient or didn’t qualify for coverage, according to the U.S. Justice Department, which intervened in the case and investigated claims made from 1998 to 2006. In some of those cases, the patients were admitted without meeting Medicare criteria in order to qualify them for subsequent skilled-nursing care, while others were admitted for placement of carotid artery stents, stays that Medicare doesn’t cover, the Justice Department said in a news release.
The nurse, Tami Ramsey, worked as a case manager for the hospital for seven weeks and observed “systematic admission to inpatient status whose hospital stay and medical treatment are clearly not eligible for reimbursement,” according to her lawsuit filed in 2004.
Kirk Wilson, the hospital’s president and chief executive officer, said none of the problems the investigation turned up were intentional. “I think it just goes to show you that try as you may to do your very best, sometimes there are corrections that need to be made in your processes and your methods,” Wilson said in an interview. As part of a corporate integrity agreement St. Joseph’s will enter as part of the settlement, Wilson said, the hospital will participate in a pilot program establishing best practices in case-management protocol. -- by Gregg Blesch
