Halifax Hospital and Medical Center in Daytona Beach has been accused of overbilling Medicare, Medicaid and private insurers for unnecessary patient admissions and spinal surgeries and paying illegal kickbacks to physicians in a healthcare fraud whistleblower lawsuit. The government recently announced its intent to intervene in the False Claims Act lawsuit.
The lawsuit estimates that damages from the illegal kickback scheme could total as much as $178 million. Damages for all claims in the whistleblower lawsuit are in the vicinity of $200 million. If a settlement is reached or the hospital loses at trial, Elin Baklid-Kunz could stand to receive a hefty whistleblower award for stopping the fraudulent billing and payment practices.
The hospital denies any wrongdoing but has failed on both attempts to have the Medicaid/Medicare fraud suit dismissed.
Baklid-Kunz first worked in compliance and then in physician services at the Halifax Hospital. Over the course of her 15-year career with the Volusia County medical center, she said she tried to alert management to the fraudulent business practices, but that no one listened. She feared for her job and whether or not she was personally liable as she saw the hospital continue to overbill Medicare and fail to send back the overpayments.
According to the whistleblower complaint, during an audit of 2008 admissions, it was revealed that 82 percent of patients admitted for chest pain did not meet minimum criteria for hospital admission. Those admissions alone resulted in substantially overbilling insurers, including Medicare and Medicaid, for unnecessary patient-related expenses.
Once she moved to physician services, Baklid-Kunz saw firsthand the compensation structures that were built into doctor’s contracts with the hospital. Some highly-skilled surgeons were receiving bonuses of $1 million annually based on the number of surgeries performed at Halifax.
Baklid-Kunz first reported the Florida Medicare/Medicaid fraud in 2009 with the filing of her whistleblower lawsuit.
Source: Orlando Sentinel, “Halifax Hospital whistleblower at forefront of $200M alleged fraud,” April 15, 2013