Whistleblower Karin Berntsen Exposes Prime Healthcare Fraud, Leading to $65M Settlement
Karin Berntsen, the Director of Performance Improvement at Alvarado Hospital in San Diego, played a pivotal role in exposing fraudulent billing practices at Prime Healthcare. Alvarado Hospital was operated and controlled by Prime Healthcare, a rapidly expanding hospital chain.
Berntsen’s whistleblower False Claims Act (FCA) lawsuit provided critical evidence that led to a $65 million settlement with 14 Prime Healthcare hospitals. Her allegations focused on two major fraudulent schemes:
- Medically Unnecessary Admissions – Prime hospitals admitted patients who should have received lower-cost outpatient care, fraudulently billing Medicare and Medicaid for unnecessary inpatient services.
- Upcoding Fraud – Prime inflated billing codes to charge for higher-cost services than those actually provided, increasing government reimbursements.
Prime Healthcare CEO Held Financially Responsible
As a result of the settlement, Prime Healthcare paid $61.75 million, and its founder and CEO, Dr. Prem Reddy, was personally required to pay $3.25 million—a rare instance of direct executive accountability in healthcare fraud cases.
A Whistleblower’s Fight for Justice
Berntsen understood that Prime’s rapid growth was fueled, in part, by fraudulent overbilling practices. Her efforts, alongside years of government investigation and litigation, ultimately held the company accountable.
Despite battling illness, Karin Berntsen dedicated immense time and energy to this case, ensuring that taxpayer dollars were protected. For her courage and determination, she was honored as “2018 Whistleblower of the Year” at the Taxpayers Against Fraud Education Fund conference in Washington, D.C.
A Landmark Victory in Healthcare Fraud Enforcement
This case serves as a powerful reminder of the impact whistleblowers can have in exposing fraud and protecting public funds. Wilbanks & Gouinlock is proud to have represented Karin Berntsen, whose bravery led to one of the largest False Claims Act recoveries against a hospital chain.
If you have knowledge of Medicare or Medicaid fraud, you may have a potential whistleblower case. Contact Wilbanks & Gouinlock today to learn more about your legal rights and options.
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.