Scripps Health System Whistleblower Lawsuit–$1.5 Million Settlement

Case name: United States and the State of California, ex rel. Suzanne Forrest v. Scripps Health
Case type: Whistleblower & Qui Tam
Filed in: [U.S. District Court for the Southern District of California]
Docket: [Case No.: 16-cv-0643-H (BLM)]

Case Summary

On March 24, 2016, Sanford Heisler Sharp filed a whistleblower action under the False Claims Act on behalf of the U.S. Government and the Relator, a former Director of Business Operations at San Diego’s Scripps Health System.

The Complaint alleged that Scripps Health, a non-profit healthcare system that includes four hospitals and 19 outpatient facilities, committed violations of Medicare, Medi-Cal and TRICARE billing requirements that resulted in the fraudulent collection of government reimbursements.

According to the Complaint, the Relator witnessed an array of fraudulent schemes. These included billing the Government for physical therapy services on behalf of physicians who were not present when the services were rendered, in violation of Medicare rules. The Relator also observed that Scripps maintained the practice of altering medical diagnoses to ensure payment, and that the goal of the hospital’s “Denials Committee” was to ensure a nearly 100% Medicare and Medi-Cal reimbursement rate, according to the Complaint.

When the Relator reported the evidence of her investigation to supervisors, the Complaint alleged, she faced retaliation and was ultimately forced to resign.

In January 2018, the parties announced a settlement in which Scripps Health agreed to pay the Government $1.5 million to resolve the claims brought by the whistleblower.