In 2006 Shands Healthcare hired Terry Myers and his consulting firm YPRO Corporation to audit six of its hospitals to see if the patients met inpatient requirement set forth by Medicare and Medicaid. Myers alleged in his qui tam complaint that he suggested the hospital self-disclose the audit problems that were uncovered. When hired again in 2007, it appeared to Myers that the problems were even worse than in 2007: Shands Healthcare did not self-disclose to the Government that a significant percentage of patients should not have been admitted to the hospital as inpatient.
On August 19, 2013, the Government announced a settlement with Shands Healthcare in the amount of $26 million to resolve allegations that it billed for inpatient services that should have been billed as outpatient. The six Florida Shands Healthcare system hospitals involved in this settlement are: Shands at Jacksonville, Shands at Gainesville (also known as Shands at the University of Florida); Shands Alachua General Hospital; Shands at Lakeshore; Shands Starke and Shands Live Oak. “Regardless of the complexity of these schemes to siphon off crucial health care dollars,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, “our law enforcement officials will work tirelessly to seek justice.”
Hospital inpatient fraud is a serious and costly and problem nationwide. Courageous whistleblowers are needed to stem the tide of this continuing problem.