ORLANDO – A nurse who blew the whistle on a hospital allegedly overcharging for treatments and using leftovers from single-dose chemotherapy drugs will get $376,452, according to a settlement announced recently.
The award is part of $2.09 million settlement the Adventist Health Care system will pay to the government in response to a false claims lawsuit filed in federal court. Heather Huddleston, who served as a nurse with Adventist during the time period the hospital submitted the false claims, will receive the money for her role in providing key evidence in the case.
Adventist had admitted to some cases of health care fraud as early as 2012, with the government levying a penalty of just more than $800,000 in that case. Huddleston, however, alleged that Adventist’s fraudulent activities went deeper than what it had admitted to the government, including the “upcoding” of treatments, a practice of assigning a different billing code to a treatment to receive a higher reimbursement from Medicare.
Huddlston’s attorney, James Young of Morgan and Morgan, told the Florida Record that his client had repeatedly complained to management about both the practices and the underreporting of the problem to the government.
“That’s the reason why this became a big deal to (Huddleston),” Young said. “Had (Adventist) done the right thing to begin with, we wouldn’t likely be here today.”
Huddleston’s case was filed in February 2013.
Experts said that reusing the vials of chemotherapy drugs is particularly dangerous, as the one-use vials could be contaminated once opened. Recipients of the drug often have weakened immune systems, making contamination even more problematic than for other patients. Chemotherapy is a powerful mixture of chemicals that target cancer cells.
Young said the outcome was about what was expected. Under the False Claims Act, a qui tam witness, or “whistle-blower,” can receive up to 30 percent of an award more than $1 million recovered from the case.
The government, according to Young, has to rely heavily on whistle-blowers, as very little oversight or auditing is typically performed, particular in cases of Medicare and Medicaid reimbursements.
“The government can’t audit or oversee every payment or procedure,” Young said. “There’s a great deal of trust.”
Adventist will receive credit for the $819,828 in penalties they admitted to in 2012. The result caps a two-and-a-half year court process.
Morgan and Morgan recovered money in a similar case against Adventist in March of last year. In that case, a radiation oncologist received more than $1 million of a $5.4 million settlement after he helped the government bring forth allegations that the hospital had allowed unqualified employees to administer radiation treatments for cancer patients.