$144 M to the feds, $21 M to whistle-blower

The largest settlement ever with a Medicare contractor came down this past July when Blue Cross and Blue Shield of Illinois pleaded guilty to defrauding Medicare. The company admitted to concealing evidence - falsifying and destroying records - of its poor performance in reviewing and paying claims of beneficiaries from 1984 to 1995 and paid $4 million in criminal fines and will pay $140 million in a civil settlement of charges under the False Claims Act. Deceptive reports had resulted in it receiving $1.3 million in government performance bonuses to which it was not entitled. The whistle-blower was an employee, and according to the Justice Department, she will receive $21 million for her action. t

Following are names and telephone numbers of sources quoted in this issue:

Russell Massaro, MD, executive vice president, accreditation operations; George Stevens, associate director, department of standards; Chuck Mowll, executive vice president, government relations and external affairs, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL. Telephone: (630) 792-5000.

Ann Ropp, vice president, women's and children's services, St. Luke's-Shawnee Mission Health System, Kansas City, MO. Telephone: (816) 932-5705.

Marcia Patterson, RN, director, obstetric services, Rush-Presbyterian-St. Luke's Medical Center, Chicago. Telephone: (630) 983-6993.

Thomas A. Massaro, MD, chief of staff, University of Virginia Health System, Charlottesville. Telephone: (804) 982-4323.

Marguerite Beck, spokesperson, University of Virginia Medical Center, Charlottesville. Telephone: (804) 924-5679.

Wilma McCullough, quality assurance manager, Monsour Medical Center, Jeannette, PA. Telephone: (724) 527-0693.

National Center for Missing and Exploited Children, Arlington, VA. Telephone: (703) 235-3900; fax: (703) 235-4067; 24-hour hotline: (800) THE-LOST (843-5678).

Patrice Spath, ART, consulting editor, Hospital Peer Review; health care quality consultant, Brown-Spath & Associates, Forest Grove, OR. Telephone: (503) 357-9185; fax: (503) 357-9267; e-mail: [email protected]; World Wide Web: http://www.brownspath.com.

Michael Cohen, president; Susan Proulx, PharmD, vice president of operations, Institute for Safe Medication Practices, Warminster, PA. Telephone: (215) 956-9181.

William E. Golden, MD, principal clinical coordinator, Sandy Grinder, RN, BSN, CPHQ, Health Care Quality Improvement Program Director, Arkansas Foundation for Medical Care, Fort Smith. Telephone: (501) 686-5236.

· Missouri Patient Care Review Foundation, 505 Hobbs Road, Suite 100, Jefferson City, MO 65109. Telephone: (573) 893-7900.

· Melinda Stone, TeamSelect, Wishard Hospital, Department of Medicine, Room M-200, 1001 West 10th St., Indianapolis, IN 46204. Telephone: (317) 630-7636. Toll-free: (888) 218-9014.

· Janice Derry, Managed Care Solutions, Jefferson Plaza Building, 1 Virginia Ave., Suite 350, Indianapolis, IN 46204. Telephone: (317) 263-0355.

· Cheryl Griffith, Health Care Excel Inc., 9502 Williamsburg Plaza, Suite 102, P.O. Box 23540, Louisville, KY 40222. Telephone: (502) 339-7442.