Whistleblower Exposes Shands Hospital Overbilling, Leading to $26M Settlement

Wilbanks & Gouinlock (W&G) successfully prosecuted a qui tam lawsuit against Shands Healthcare in Florida, resulting in a $26 million settlement. The case alleged that Shands improperly billed Medicare and Medicaid by admitting patients for inpatient care when outpatient treatment was medically appropriate—a scheme designed to collect higher reimbursements from the government.

Inpatient vs. Outpatient Billing Abuse

At the heart of the case were medical necessity violations, where Shands routinely admitted patients unnecessarily to maximize profits. These outpatient overbilling practices led to a $22 million settlement related to improper inpatient admissions, and an additional $3 million was recovered for outpatient billing fraud.

Major Win in Outpatient Overbilling Case

This case remains a landmark example of outpatient overbilling, underscoring the critical role whistleblowers play in protecting public healthcare funds. The Shands Hospital settlement sends a clear message that fraudulent billing practices will not be tolerated.

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.