In 2006, Columbia/HCA was forced to return $1.7 billion to the federal government for defrauding Medicare. How was the federal government able to amass such strong evidence against HCA in order to win such a large settlement?
The answer to the question is revealed in a book called Undercover by John W. Schilling. The book details how Mr. Schilling, a former accountant of HCA, found significant irregularities in HCA’s Medicare reimbursement charges. When his concerns were voiced about this illicit behavior, his bosses told him to ignore the issue. But Mr. Schilling did not ignore the issue. Instead he filed a qui tam whistleblower lawsuit an in the process became a multi-millionaire.
The book is interesting in that it goes into such vivid detail with respect to how deciding to reveal Medicare fraud alters one’s life. It is interesting to see how the Schilling uncovers lies on top of lies. By filing the suit, Schilling knew he would be excommunicated from the health care finance industry; this led to significant strain on his personal, family, and financial life.
Most of the blame for the fraud is of course heaped upon HCA, the worthy culprit. But some of the blame is also place on Medicare, whose complex reimbursement schemes often make hospital reimbursement decisions fall into a gray area.
While the book stimulates readers by revealing the truth behind what happens in whistleblower cases, the book isn’t necessarily a page turner. The writing style is: this happens, then that happens, then this happens. Schilling always portrays himself positively; he is always the best witness or the most honest person. While this may or may not be true, I would say that Schilling has an unbiased point of view.
Nevertheless, if you really want to know what it takes to expose fraud in the health care industry on a grand scale, this book reveals a the dirty underbelly of the health care industry rarely visited.
- Schilling, John W. (2008) “Undercover: How I Went from Company Man to FBI Spy — and Exposed the Worst Healthcare Fraud in US History,” AMACOM, 304 pages.