Illinois Healthcare System Settles Whistleblower Lawsuit Alleging Overpayment for Services for $12.5M

A whistleblower lawsuit filed against St. Elizabeth’s Hospital of the Hospital Sisters Health System in Illinois has been settled for $12.5 million. The multi-institutional healthcare system that sponsors 15 hospitals in 14 communities across Illinois and Wisconsin, as well as an integrated physician network, is alleged to have committed billing errors that may have resulted in an overpayment for services.

According to a news release, the hospital submitted claims for urgent care services billed at a higher level of service. When the errors were brought to the attention of St. Elizabeth, the hospital fully cooperated with the Department of Justice’s investigation.

St. Elizabeth did not admit wrongdoing but has agreed to settle the claims to avoid the expense and uncertainty of litigation. The claims are allegations only, and there has been no determination of liability. Under the False Claims Act, private citizens, known as relators, can bring suit on behalf of the United States and share in any recovery.

False Claim Act whistleblowers can be awarded up to 30 percent of the recovery. The upper limit if the whistleblower, or relator, in a qui tam case moves forward without the government joining as a plaintiff. If the government joins the lawsuit, the maximum reward is 25 percent.

As we wrote about earlier this year, settlements and judgements under the False Claims Act surpassed $2.2 billion for the fiscal year ending Sept. 30, 2022. Of that, $1.7 billion related to matters involving the healthcare industry, including drug and medical device manufacturers, durable medical equipment, home health and managed care providers, hospitals, pharmacies, hospice organizations, and physicians.

The Health Law Offices of Anthony C. Vitale can assist clients accused of healthcare fraud under the False Claims Act. Our attorneys also are well-versed in handling cases relating to the Anti-Kickback Statute and Stark Law. We also represent clients in whistleblower actions as well as plaintiffs who file whistleblower actions. Give us a call at 305-358-4500, or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.