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Medicare Compliance & Reimbursement

COMPLIANCE NEWS:

Are Internal Auditors Obligated to Report Adverse Findings to Medicare? Genesys Cardiology Qui Tam Lawsuit Raises Questions

Published on Thu Jan 28, 2010

The case stirs debate over the ethics of auditors turning complainants. Genesys Health System recently paid close to $670,000 to settle a False Claims Act lawsuit initiated by an internal auditor who blew the whistle on alleged upcoding of cardiology evaluation and management services at the organization. What happened: The government alleged that Genesys, a multi-facility organization in Michigan, over-billed Medicare from 2001 to 2007 for evaluation and management services rendered to cardiology patients, according to a Department of Justice release. The whistleblower in the case received a $133,882 share of the settlement, notes the DOJ. Read the government's lips: "The relator can be proud that she brought these serious allegations of Medicare fraud to our attention and paved the way for the government to uncover the false claims," said Terrence Berg, U.S. Attorney for the Eastern District of Michigan, in a DOJ release. "It is important that anyone who [...]
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