$9.5 million recovery for Medicare fraud related to improper use of inpatient status by hospital

In July of 2016, Cory Fein, working with co-counsel, successfully recovered a $9.5 million settlement for false Medicare claims submitted by the largest health care provider in Reno, Nevada. The case, filed in 2012 in the U.S. District Court for Nevada, is styled United States ex rel. Cecilia Guardiola v. Renown Health, et al; No. 3:12-cv-00295. Cory Fein and his co-counsel represented Cecilia Guardiola, a registered nurse who was hired by Renown Health in 2009 as Director of Clinical Documentation. She discovered that Renown had a systematic problem billing Medicare for inpatient claims that should have been categorized as outpatient claims. Although Guardiola brought these problems to the attention of Renown’s senior management, she found a lack of institutional resolve to correct the problem. When she learned from various physicians that the false claims were being submitted at the direction of certain Renown Health management, she realized that her efforts would never succeed and resigned. After the United States decided not to intervene in the case, Fein and his co-counsel continue to pursue the case without the Government, as allowed by the False Claims Act, resulting in the successful recovery.