The United States Department of Justice settled a False Claims Act Medicaid fraud case against a Florida hospital system. Four Florida hospitals paid $20 million to resolve allegations that they made donations to a county juvenile wellness board to improperly fund the state’s share of Medicaid payments to the hospital system. A whistleblower reported this misconduct. A former hospital reimbursement manager blew the whistle and will receive $5 million of the settlement.
According to the allegations, BayCare hospitals essentially laundered money through the state Medicaid program. Over a period of two years, the hospital system made cash donations to the Juvenile Welfare Board of Pinellas County (JWB). The JWB then “transfer[red] a portion of the cash donations to the State of Florida’s Agency for Health Care Administration for Florida’s Medicaid Program.” As Medicaid is both federally and state-funded, federal Medicaid “matched” those donated funds, which were then “returned to the BayCare hospitals as Medicaid payments.” The hospital system not only received back its original donation but also made money in the form of matched federal Medicaid funds.