Opinion ID: 783447
Heading Depth: 2
Heading Rank: 2

Heading: Relator's Original Complaint and Written Disclosure

Text: 11 In the meantime, Relator filed his qui tam action in February of 1998. The original complaint alleged that the Cookville Regional Medical Center (Cookville), one of the original named defendants, perpetrated a scheme of defrauding the United States Government by unbundling services and billing Medicare and Medicaid, and that CHS and other defendants engaged in a scheme of defrauding the United States Government by miscoding and upcoding items billed to Medicare and Medicaid. (J.A. at 25.) Count One of the complaint alleged that the defendants knowingly presented, caused to be presented, or conspired to present false claims in violation of 31 U.S.C. § 3729(a)(1). (J.A. at 25.) Count Two alleged that the defendants agreed to undermine [the Medicare and Medicaid] laws, rules, and regulations and that they conspired... to defraud the government by acting collectively to submit or cause to be submitted false and fraudulent claims for payment to the United States in violation of 31 U.S.C. § 3729(a)(3). (J.A. at 26.) 12 With the sealed complaint, Relator also furnished to the government, as required, a written disclosure of substantially all material evidence and information [he] possesse[d]. 31 U.S.C. § 3730(b)(2). In the written disclosure, Relator indicated, in pertinent part, that he had witnessed first-hand, or learned from others about, (1) unbundling 4 of services while working at Cookville; (2) upcoding of contract services and disposable equipment, as well as fraudulent inflation of cost reports, in White County Hospital's nursing and respiratory departments; (3) misuse of a doctor's medical provider number in the emergency room; (4) double billing and billing for unbillable items; (5) improper changing of patients' statuses from an outpatient/observation status to an inpatient status; (6) billing for fictitious continuous heart monitoring; and (7) improperly premature discharging of hospital patients when Medicare reimbursement eligibility had been exhausted. In support of his allegations, Relator also provided a list of hospital employees and asserted his possession of supporting documents. 13