A whistle-blower is accusing the Cleveland Clinic of performing unnecessary tests on patients to squeeze money out of the government. The government, however, declined to join the case.
The complaint was filed under the False Claims Act in March 2014 and unsealed last week after the U.S. Justice Department declined to intervene. Dr. Sam Ghoubrial, a physician who has referred patients to the Cleveland Clinic, alleges in the lawsuit (PDF) that the health system performs tests such as echocardiograms and MRIs on patients even though they already had the same tests before arriving.
The Cleveland Clinic, in a statement, denied the billing allegations and emphasized that the whistle-blower in the case is not a Cleveland Clinic physician. “We are pleased that the federal government declined to pursue his claims, and we fully expect to prevail in any litigation,” the system said in the statement.
In False Claims Act cases, a whistle-blower files a lawsuit on behalf of the government, which then has the option to join. In successful cases, whistle-blowers are entitled to a percentage of whatever money the government is able to recover.
Ghoubrial also alleges the hospital intentionally performed the duplicate tests outside the 72-hour window before surgeries to skirt Medicare's DRG billing system.
In False Claims Act cases, defendants are at risk of having to pay triple damages if found liable.
Follow Lisa Schencker on Twitter: @lschencker