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Judge Allows MedStar Health False Claims Act Case to Go Forward

Judge Allows MedStar Health False Claims Act Case to Go Forward


Often, some of the firms involved in allegations of False Claims Act violations come up more than once in this blog. This is the case with MedStar Health. Last month an Illinois Judge – Judge Robert Dow Jr. of U.S. District Court Judge in Illinois – ruled that a False Claim Act violation case could proceed against MedStar and Accretive. The suit was first filed by MedStar Washington Hospital Center employee Cherry Gaziosi who alleged that she helped submit false claims to Medicare, Tricare and Medicaid on behalf of Accretive Health Inc. Accretive Health is based in Chicago and is one of the largest hospital revenue cycle management companies in the United States. In January of this year, Accretive Health changed its name to R1 RCM Inc. Tricare is a health care program for uniformed service members and their families.


Specifically, Gaziosi alleged that MedStar conspired with Accretive in order to change patient treatments solely to increase patient admissions. Moreover, Gaziosi maintains that these changes were made without regard to medical necessity. As a result of this action, Medicare is believed to have paid more for inpatient admissions than it did for observational stays. “Accretive for a number of years peddled a practice to top hospital administrators at a significant number of hospitals around the country, convincing them that Accretive could provide to the hospitals what they called a ‘revenue lift’ particularly from the Medicare system,” Brad Pigott of Pigott & Johnson PA in Jackson, Miss. Pigott represents Ms. Gaziosi and is a False Claims Act attorney. The qui tam provisions of The False Claims Act allow whistleblowers to sue on behalf of the government and to receive a portion of any damages recovered.


Gaziosi further alleged that Accretive created documentation, which sought to justify inpatient admissions for patients who were otherwise determined not to have met a medical necessity. Emergency department staff previously made this determination. In 2015, MedStar Health was among 500 hospitals that paid a $250 million dollar settlement to the U.S. Department of Justice for irregularities concerning the implantation of cardiac devices in Medicare patients. Drinker Biddle & Reath LLP in Washington represents MedStar. Kirkland & Ellis LLP in Washington represents Accretive.


If you know of abuse that has been committed against the government or one of its agencies, you are encouraged to report it and to contact a whistleblower lawyer. Whistleblower lawyers will be able to advise you in such matters and will work to protect your rights.