Former SRHS worker files lawsuit against healthcare system, clai - FOX Carolina 21

Former SRHS worker files lawsuit against healthcare system, claims schemes to defraud government

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SRHS lawsuit. (October 18, 2016 FOX Carolina) SRHS lawsuit. (October 18, 2016 FOX Carolina)

A former Spartanburg Regional Health System worker has filed a lawsuit against the health care system. 

The lawsuit claims Spartanburg Regional Health System took part in a scheme to defraud the federal government by filing false claims through referrals.

Greenville Attorney R. Mills Ariail Jr. is representing the former SRHS employee, Elisabeth Markley. She started working for Spartanburg Regional in 2013, but was let go last year. Markley's job as a physician compensation coordinator involved overseeing pay and benefits for doctors. Now she's suing her former employer. 

Her suit states several doctors' offices were acquired by the hospital system and the doctors were overpaid, with an understanding that their patients would be sent to Spartanburg Regional for more extensive tests or procedures.

"Spartanburg Regional has paid doctors in excess to what they should be paid. In order to get referrals back to the hospital. Which basically means more revenue for more referrals,"  attorney Ariail said. 

All of those procedures were then billed to Medicare, Medicaid and Tricare, the lawsuit says.

"Arising from unlawful schemes to defraud the United States of America, the Medicare, Tricare and Medicaid programs, in particular by SRHS's submission of false and fraudulent Medicare, Tricare and Medicaid claims for reimbursement to the United States Government, in violation of the False Claims Act...." the lawsuit states.

Ariail said Markley uncovered a kick-back scheme that involved millions of dollars and they claim violated what's called the Stark law. The law governs how doctors refer Medicare and Medicaid patients.The lawsuit states: 

The Stark Statute prohibits a hospital from submitting a claim to Medicare for "designated health services," that were referred to the hospital by a physician with whom the hospital has a financial relationship," unless a a statutory exception applies."

The lawsuit claims other laws were violated including the False Claim Act. Spartanburg Regional provided a statement to Fox Carolina: 

Spartanburg Regional Healthcare System categorically denies all allegations of former employee, Elisabeth Markley, and will vigorously defend against these meritless claims. The government has been investigating her claims since September 2015 with our full cooperation and to date has not seen fit to join her lawsuit. Spartanburg regional healthcare system is confident that ms. Markley's allegations have no basis in fact or law.

Markley's attorney stands behind those allegation and added his client even saw paperwork charging patients for procedures they never got. A nurse out of North Carolina took part in practice called "code cloning." The nurse added practices to the patient's chart, but the lawsuit claims those procedures were never done. 

Ariail said his client was fired from the health care system without any written complaint or reason. 

"As a result, not only do we believe that she was discriminated against, she was discharged in a retaliatory manner based on raising these issues and letting them know, 'you're violating the law here'," Ariail said. 

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