Billions of dollars are wasted every year due to scams and corruption involving Medicare fraud. In fact, $5 billion of the $5.6 billion total False Claims Act settlements and judgments of 2021 were related primarily to Medicare and Medicaid fraud.

When an individual or organization commits Medicare fraud, they take significant resources away from necessary health care services putting beneficiaries’ health and welfare at risk. Let’s take a look at a recent Medicare fraud case brought to light by a whistleblower.

University of Miami Pays $22M to Settle False Claims Act Allegations

In 2021, the University of Miami agreed to pay $22 million in fines and penalties after a whistleblower accused the university of Medicare fraud. According to the Department of Justice (DOJ), a former senior executive at the school had provided information claiming the university’s off-campus hospital facilities had engaged in three violations of the False Claims Act.

  1. The University of Miami knowingly engaged in improper billing relating to its hospital facilities. Medicare regulations require hospital facilities to notify beneficiaries when their Medicare program will face higher costs when receiving service. According to court documents cited by the DOJ, the university allegedly converted several of their physicians’ offices to hospital facilities and then sought payment at higher rates without informing Medicare program beneficiaries.
  2. The University of Miami billed federal health care programs for unnecessary lab tests for patients who received kidney transplants at the Miami Transplant Institute–a transplant program operated by the University of Miami and Jackson Memorial Hospital. According to DOJ allegations, every time a kidney transplant patient checked into the Miami Transplant Institute, the University of Miami’s electronic system ordered a standard protocol of tests regardless of whether they were necessary for the particular patient.
  3. The University of Miami allegedly had Jackson Memorial Hospital purchase pre-transplant lab tests from the university at inflated costs.

This case is a prime example of the seriousness of Medicare fraud and how powerful whistleblowers are in enacting change and demanding justice. Full details of the settlement can be found here.

DJO is comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can bring fraud to light.

If a whistleblower’s lawsuit is successful, the reward can be between 15% to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation.

DJO will be there every step of the way to ensure you are safe and your information is confidential so you will have confidence knowing you’re doing the right thing. If you have valuable information that can help expose fraud, we encourage you to speak to our experts today.

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