Whistleblower Helps Combat Healthcare Fraud – is Rewarded in Qui Tam Lawsuit Alleging Medicare Fraud at Banner Health
Whistleblower law firm Kohn, Kohn & Colapinto congratulates qui tam whistleblower Cecilia Guardiola for helping the federal government combat Medicare fraud. Ms. Grardiola will receive approximately $3.3 million out of the $18 million settlement the Department of Justice announced on April 12, 2018.
Ms. Guardiola, a former employee of Banner Health, filed a lawsuit under the qui tam provision of the False Claims Act (FCA). The lawsuit alleged that Banner Health knowingly submitted false claims to Medicare by admitting patients at 12 of its hospitals who could have been treated as outpatients. The $18 million settlement also resolves allegations that Banner Health inflated in reports to Medicare the number of hours for which patients received outpatient observation care during this time.
These types of qui tam actions in healthcare are an essential tool in combating Medicare fraud. “The truth of the matter is that the government would have recovered nothing if the whistleblower remained silent,” asserts qui tam lawyer Michael Kohn. “The False Claims Act qui tam provision is the real powerhouse behind the government’s ability to combat healthcare fraud, Kohn added, In fact, Qui tam whistleblowers accounted for over 90% of all fraud recoveries obtained under the False Claims Act in 2017,” Kohn added.
The qui tam provisions of the False Claims Act allow persons and entities with evidence of Medicare fraud against federal programs or contracts to sue the wrongdoer on behalf of the United States government. In qui tam actions, the government has the right to intervene and join the action. The United States Government is required to compensate whistleblower who initiate successful qui tam actions.
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March 19, 2025
