DOJ Joins Whistleblower Case Against Prime Healthcare for Medicare Fraud
In the case U.S. ex rel. Bernsten v. Prime Healthcare, et al., pending in the United States District Court for the Central District of California, the U.S. Department of Justice (DOJ) has joined forces with Wilbanks & Gouinlock (W&G) and co-counsel James, Hoyer, Newcomer & Smiljanich of Tampa, Florida, to prosecute a major Medicare fraud case against Prime Healthcare and its founder and CEO, Dr. Prem Reddy.
Improper Inpatient Admissions to Inflate Medicare Reimbursements
The whistleblower lawsuit alleges that Prime Healthcare engaged in a systematic scheme to admit Medicare patients as inpatients regardless of medical necessity in order to maximize reimbursements. According to the complaint, Dr. Reddy directed physicians and staff to admit patients even when their conditions didn’t meet the clinical criteria for inpatient care—simply because Medicare pays more for inpatient treatment than for outpatient care.
To carry out the scheme, Prime Healthcare altered medical records and trained staff to exaggerate patient conditions in order to justify improper inpatient admissions. These alleged actions significantly inflated the amount the hospitals were reimbursed by Medicare, resulting in substantial losses to U.S. taxpayers.
Ongoing Litigation to Combat Medicare Fraud
With the DOJ now actively involved, W&G and its co-counsel are preparing to litigate the Medicare fraud case on behalf of the American public. The collaboration underscores the seriousness of the allegations and the government’s commitment to holding healthcare providers accountable for abusing federal programs.
This case is one of several high-profile efforts to fight Medicare fraud, protect the integrity of the healthcare system, and recover taxpayer dollars lost to fraudulent billing practices.
Report Fraud at No Cost
If you have information about fraudulent practices, contact our office for a free, confidential consultation:
- Fill out our consultation form by clicking here.
- Email us at info@wilbanksgouinlock.com.
- Call (404) 842-1075, ext. 123 or 122.
This article is for informational purposes only and should not be considered legal advice.