Renown Health Enters Into Settlement With Dept. of Justice Over Medicare Fraud Allegations
Renown Health has entered into a settlement agreement with the U.S. Department of Justice to resolve civil allegations of health care fraud to the Medicare system.
Renown Health, a non-profit corporation which operates Renown Regional Medical Center and Renown South Meadows Medical Center in Reno, has entered into a settlement agreement with the U.S. Department of Justice to resolve civil allegations of health care fraud to the Medicare system, announced U.S. Attorney Daniel G. Bogden for the District of Nevada on Thursday.
The settlement agreement, effective June 29, 2016, arises out of a civil lawsuit filed on June 1, 2012, by Cecilia Guardiola pursuant to the whistleblower provisions of the False Claims Act. The civil lawsuit alleged that Renown submitted false claims to the Medicare program for inpatient hospital services performed at Renown Regional Medical Center and Renown South Meadows Medical Center from June 1, 2006, through June 30, 2014. The lawsuit alleged the services should have been billed on a less expensive outpatient or observation basis. The settlement agreement states that Renown shall pay $9.5 million no later than June 30, 2016. Under the False Claims Act, Guardiola, also known as the relator, will be paid approximately $1.7 million, as soon as feasible after the United States receives its portion of the settlement amount from Renown. The settlement agreement states that it is neither an admission of liability by Renown Health nor a concession by the United States that its claims are not well founded.
Since January 2009, the Justice Department’s Civil Division, along with U.S. Attorney’s Offices around the country, has recovered a total of more than $29.9 billion through False Claims Act cases, with more than $18.3 billion of that amount recovered in cases involving fraud against federal health care programs.
Assistant United States Attorney Roger Wenthe handled the case on behalf of the U.S. Attorney’s Office.
The case was investigated by the Office of the Inspector General of the Department of Health and Human Services.
(The Department of Justice contributed to this report.)
Statement from Renown Health:
"Renown Health settled a lawsuit made public by a former employee in 2013 regarding technical billing issues surrounding types of patient care. These types of lawsuits are becoming increasingly common nationwide. After the federal government evaluated the case, they decided not to pursue any action. The plaintiff, however, decided to pursue the case on her own. After careful consideration we made a decision to settle the lawsuit rather than to pursue a lengthy and costly defense."