Plaintiffs claimed federal false claims violations for numerous forms of Medicare fraud. Plaintiff also alleged she was denied promotion from interim to permanent Chief Financial Officer of the Hospital because of her sex. The government intervened in the case. the complaint alleged falsification of DRG (Diagnostic Related Group) assignment of a diagnosis and/or procedure to a patient even though the patient had not experienced that particular illness or procedure, embellishment and enhancement of a particular diagnosis to increase reimbursement. the complaint further alleged that the hospital administrator would illegally enhance these false diagnosis by use of prohibited software. Nurse practitioners would then assist the chief executive officer in choosing plausible alternative (but highly paid) diagnosis and the CEO would discard those not used.
Editor’s note: This lawsuit was chosen for inclusion in the National Qui Tam Action Handbook. The case resulted in a settlement of 3.5 million dollars. In the twenty five years since we started litigating federal false claims, there has been a complete reversal in the categories of false claims cases. While there is the occasional outlier case (like our federal crop insurance fraud case in the Fresno, Tulare and Kings County areas of California), most of our aerospace fraud cases have now been replaced by health care fraud against medical offices and large institutions. As our case results page indicates, many large pharmaceutical manufacturers have paid hundreds of millions for Big Pharma fraud, including off-label prescribing.
Stephen Danz has over 30 years of practical legal experience, trying hundreds of cases within that time. Regularly appearing before the state and federal courts throughout the state of California, Mr. Danz has earned a reputation as a leading attorney for plaintiffs employment law. He is admitted to practice law in ALL federal and state courts of California. For the federal bar, that includes the Northern, Southern, Eastern and Central Districts of California. He is authorized to practice in all 52 counties of California.