The federal Sixth Circuit Court of Appeals has reversed the dismissal of a whistleblower lawsuit brought against Erlanger Health System.
A three-judge panel ordered the case be remanded to Middle District of Tennessee Judge Todd J. Campbell.
Robert Whipple, who worked briefly at Erlanger, alleged that the hospital had violated the False Claims Act by knowingly submitting false or fraudulent claims for reimbursement to federally funded healthcare programs.
The federal government opted not to pursue the whistleblower action, however the case continued on appeal.
Mr. Whipple claimed that he discovered the alleged fraud during the six-month period he worked for Erlanger in early 2006, first as a revenue cycle consultant on assignment from ACS Healthcare Solutions and then as Erlanger's interim director of care management.
The 13-page opinion says that, unbeknownst to Mr. Whipple, the government conducted an audit into concerns about Erlanger billing to Medicare. That ended with Erlanger making a $477,140.42 refund to the government in September 2009.
Mr. Whipple disclosed his whistleblower claims to the government in October 2010, and his lawsuit was filed under seal in March 2011. The government declined to intervene in April 2012.
Afterward, Erlanger obtained the dismissal of the complaint.
The opinion concludes, "Accordingly, the district court's dismissal of Whipple's short-stay, same-day-surgery, and renal dialysis claims as barred under (section of federal law) is reversed, and the matter is remanded for further proceedings consistent with this opinion."
To read the full opinion, click here.