Tennessee health system must face nurse practitioner's false claims retaliation suit

Memphis, Tenn.-based Baptist Memorial Health Care Corp., and its physician group must face a retaliation lawsuit filed by a nurse practitioner who claimed the organization violated the False Claims Act by retaliating against her for raising billing fraud concerns, a Tennessee district court ruled May 2. 

Margaret Allgood, who began working as a nurse practitioner at the medical group in 2012, claims that she witnessed several instances of billing fraud.

In particular, Ms. Allgood said she observed a nurse practitioner for the Baptist medical group perform a procedure on one of her patients in March 2018, but a few months later saw a procedure note that said a physician, John King, MD, performed the operation. According to the lawsuit, Ms. Allgood also performed an interrogation procedure for another patient and was told it was a standard practice to bill all interrogations under Dr. King's name. Since Medicare pays more for a physician service than a service performed by a nurse practitioner, Ms. Allgood alleges the medical group received overpayments from false claims.

Ms. Allgood claims that in attempting to report the fraud to the government, she looked up the health records of the two instances. The organization then started an investigation into Ms. Allgood to see if she violated HIPAA by accessing the patient records. The investigation found she was engaging in a protected act because she was attempting to report billing fraud, according to the lawsuit. 

Ms. Allgood claims that she was suspended with pay for four months shortly after reporting Dr. King's alleged billing fraud, which was a form of retaliation. 

Ms. Allgood is seeking front pay in lieu of reinstatement, back pay, special damages, and a declaratory judgment that she did not violate HIPAA.

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