- A whistleblower lawsuit filed under the False Claims Act that accuses the Cleveland Clinic of "improper and excessive billing" was unsealed on Tuesday. The plaintiff, Dr. Sam Ghoubrial, is a physician from Wadsworth who "has witnessed many of these events firsthand through his patients, through his friends, through his family, and as a referring practitioner," according to the suit.
- When federal prosecutors in Cleveland declined to pursue the case, Ghoubrial and his attorney decided to prosecute.
- A Cleveland Clinic spokesperson has denied the allegations, as well as making the point that Ghoubrial is not a Cleveland Clinic employee. "We are pleased that the federal government declined to pursue his claims, and we fully expect to prevail in any litigation," the statement said.
Given that the feds declined to take on the case, it seems likely that Ghoubrial may have bitten off more than he can chew.
"When the government chooses not to intervene, it decreases the probability of success by the relator, and Cleveland Clinic likely views it as good news that the government didn't intervene in this case," said Scott Becker, partner at McGuireWoods.
According to the lawsuit, the Cleveland Clinic performed thousands of unnecessary tests outside of a 72-hour payment window used by the Diagnosis Related Group billing system in order to boost its Medicare reimbursement.
"The Cleveland Clinic will expose the patient to unnecessary radiation, unnecessary tests, and unnecessary financial hardship," the lawsuit says. "Medicare, as well as the patient, is incurring the loss."