Medicare Fraud: S. California Hospital’s $2.2 Million Fraud Payout

The experiences of a Medicare billing attorney demonstrate that Medicare fraud is more prominent than the general public might think. Hospitals providing services to the elderly have been found to have skewed or inflated their charges to obtain more reimbursement from the federal government. The result of this deceit is that funding to provide medical care to other individuals, including seniors, is not available.

The prime example of the severity of Medicare fraud is the recent payout agreement in California. On September 20, 2010, the El Centro Regional Medical Center in Imperial County, California, reached an agreement with the federal Department of Justice whereby it agreed to pay $2.2 million dollars plus interest for its Medicare fraud. The impetus for this result was none other than the actions of a whistleblower who engaged the assistance of a Medicare billing attorney.

In this case, the hospital was accused of submitting false Medicare claims for typically short hospital stays when the treatment provided should have been billed as outpatient services or as visits to the hospital’s emergency room. The hospital engaged in this behavior as a means to obtain larger reimbursements from the federal government. For his assistance in bringing the problem to light, the whistleblower received several hundreds of thousands of dollars as his share of the recovery.

This case, as in other Medicare fraud litigation, was extremely complex and expensive. While the Justice Department can file a suit against a hospital, so, too, may an individual. In this case, however, it is the individual’s responsibility to finance the lawsuit and later seek reimbursement for those expenses if he prevails in court. A Medicare billing attorney can often make the process much less complicated and stressful. Sometimes, because they are litigated in federal court, a whistleblower may be required to hire a Medicare billing attorney prior to being able to pursue his claim. The presence of an attorney in this situation ensures that such a serious claim is investigated and prosecuted according to the law.

In cases of suspected Medicare fraud, an attorney can assist an individual with bringing suit against the hospital, doctor or treatment facility. A Medicare billing attorney typically has the resources and knowledge about how to pursue a claim of Medicare fraud.

A hospital that exaggerates or otherwise tampers with their Medicare billing is committing fraud; this fraud can prevent hundreds, if not millions of other people from receiving medical treatment. If you believe that a hospital is engaging in fraudulent billing procedures, consult a Medicare billing attorney about your options.


November 15th, 2010