Karin Bentsen was the Director of Performance Improvement at Alvarado Hospital in San Diego. That hospital was operated and controlled by Prime Healthcare. Ms. Berntsen brought information to the Government which formed the basis for their case against 14 Prime hospitals. She provided evidence that Prime hospitals were admitting patients to the hospital when less costly outpatient care options existed. She also provided support for her allegations that Prime routinely involved in “upcoding”. The Prime hospital system paid $61,750,000 and the founder and chief executive office of Prime – Dr. Prem Reddy – was required to pay $3,250,000 under the terms of the agreement.
Prime was growing as a company very fast. Ms. Berntsen understood one of the reasons why. She alleged that they were gaming the system by overbilling Medicare and Medicaid.
After many years of investigation and ultimately litigation, Ms. Berntsen and the Government prevailed. Ms. Berntsen provided an incredible amount of effort and energy in the case despite battling illness. For her courageous acts and willingness to step forward and protect the taxpayers by filing a whistleblower complaint, this Wilbanks & Gouinlock client was named “2018 Whistleblower of the Year” at the most recent annual Taxpayers Against Fraud Education Fund conference in Washington, D.C.