Medicare Compliance & Reimbursement

Allegedly lying about the seriousness of patients' conditions to allow the patients to jump ahead in the line for donated organs is at the center of a whistleblower suit unveiled July 28.

According to U.S. Attorney Patrick Fitzgerald and Illinois Attorney General Lisa Madigan, the Department of Justice has joined a whistleblower suit charging University of Illinois Hospital in Chicago of defrauding Medicare and Medicaid of more than $1 million by performing liver transplants that weren't yet medically necessary.

The complaint - originally filed by the former director of the University of Illinois' multi-organ transplant program, Dr. Raymond Pollak - accuses UIH of making patients appear sicker than they were so that the patients would become eligible sooner for transplants. The motive, according to the complaint: The extra surgeries allowed the hospital to make sure it met the minimum number of liver transplants necessary to keep its Medicare and Medicaid certification to conduct the procedures.

The feds are seeking triple damages - more than $3 million - from UIH. Two other facilities named in the suit, however, got off for much less. Northwestern University settled the case July 28 for a paltry $23,587, while the University of Chicago Hospitals resolved the matter for $115,000. Pollak, who's currently the director of the abdominal organ transplant program at UI's Peoria campus, will collect about $30,000 of the settlements; his attorneys will get $20,000.

The hospitals named in the suit deny any wrongdoing.

Lesson Learned: Listening up when doctors or other employees raise compliance concerns can save you time, money and hassles in the long run.