Summary Of The Whistleblower Case Cecilia Guardiola

In this Whistleblower Case Cecilia Guardiola, a former employee of Renown Health filed a lawsuit under the False Claims Act against Renown Health on June 1, 2012. The plaintiff alleged that fraudulent Medicare claims have been submitted by Renown Health for short stay inpatient claims that should have been outpatient claims. The original complaint that was filed has been seal according to order at the request of the plaintiff (Health, 2014). According to information from case Guardiola was hired by Renown Health June 2009 as Director of Clinical Documentation with main responsibility to improve the medical documentation to support and enhanced billing. Guardiola was then promoted to a new position as Director of Clinical Compliance, she later resigned in January 2012 alleged that efforts to improve the billing system were precluded by Renown. (Guardiola v. Renown Health, 2014). …show more content…

In addition, Guardiola claims that the improperly billed claims were caused by “inadequate clinical documentation to support inpatient claims, internal processes designed to improperly assign inpatient admission status, antiquated computer systems that generated false claims, and a lack of review to ensure appropriate inpatient status assignments” (Guardiola v. Renown Health, 2014). It is noted that the plaintiff Guardiola discovered the alleged insufficiencies and claimed she brought it to the attention of management, but Renown takes no action to correct the problem and did nothing to prevent it from happening. The plaintiff claims that management at Renown directed, encouraged and facilitated the deceitful action to be continued against