A former employee of Mercy Hospital in Portland, Maine, is accusing the healthcare provider of improper Medicare billing, according to a Portland Press Herald report.
Here are seven things to know about the allegations.
1. Jennifer Worthy, Mercy's former manager of patient accounts, filed a lawsuit, claiming the hospital and its billing companies took part in a scheme to get higher Medicare payments, according to the report. Ms. Worthy filed the lawsuit after resigning from Mercy in early 2014.
2. In the False Claims Act lawsuit, Ms. Worthy names Mercy Hospital, as well as the hospital's parent company, Brewer-based Eastern Maine Healthcare Systems.
3. Ms. Worthy's lawsuit accuses Mercy and the two billing companies, Chicago-based Accretive Health, now known as R1 RCM, and Escondido-based California Healthcare Medical Billing, of taking part in various plans to improperly bill Medicare, according to the report. The report cites a number of these plans noted in the lawsuit, such as "unbundling" bills and elevating the severity of patients' physician visits.
4. Mercy and the billing companies previously moved to dismiss Ms. Worthy's allegations, according to the report. U.S. District Judge John A. Woodcock Jr. dismissed some of Ms. Worthy's claims under whistle-blower protection laws because they weren't filed in time, but most of her allegations are moving forward, according to the report. Parts of the lawsuit that were dismissed relate to Ms. Worthy and her employment, the report notes. One example cited in the report is an allegation against CHMB, which was dismissed due to lack of evidence that the company could be considered her employer, instead of Mercy and Accretive.
5. Speaking on Ms. Worthy's lawsuit, Mercy spokesperson Wayne Clark told the Portland Press Herald state and federal officials looked into the former Mercy worker's claims and both declined to intervene in her lawsuit. "While the law allows the employee to pursue the claim independently, we believe the lawsuit is deficient on the law and the facts," he told the publication.
6. Jeffrey Neil Young, one of Ms. Worthy's lawyers, told the Portland Press Herald the overbilling amounts to "millions" of dollars, but he said more detailed numbers won't be available until lawyers are able to examine Mercy records as the trial proceeds.
7. Now that most of the case can proceed, Mercy is supposed to reply to the lawsuit by early next month, Mr. Young told the Portland Press Herald.
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