Whistleblower to Share in $65-Million Settlement from Prime Healthcare in Medicare Overbilling Case

A San Diego whistleblower will receive $17.2 million with the settlement of a 7-year-old false claims lawsuit against Prime Health Care regarding overbilling for Medicare services at 14 California hospitals.

The U.S. Department of Justice announced Friday that it has reached a $65-million settlement with the Ontario-based healthcare system, resolving allegations that Prime “engaged in a deliberate corporate-driven scheme to increase inpatient admissions of Medicare beneficiaries” and that the company “engaged in up-coding by falsifying information concerning patient diagnoses.” Up-coding entails making illnesses seem worse than they really are in order to increase Medicare reimbursement. (read more)