Over the past decade, Cecilia Guardiola, RN, has filed whistle-blower lawsuits against hospitals that have employed her in Texas, Nevada and Arizona, and those facilities have paid nearly $33 million to the federal government to settle those cases, according to The Republic.
Ms. Guardiola, a law school graduate, filed the cases under the qui tam provisions of the False Claims Act on behalf of the government. If these types of lawsuits are successful, the whistle-blower collects part of the recovery. Ms. Guardiola has collected $6 million from settlements in the three lawsuits she filed, according to the report.
All three of the lawsuits brought by Ms. Guardiola allege hospitals charged Medicare and Medicaid for inpatient stays when the visits should have been billed as less costly outpatient care.
In 2008, Ms. Guardiola sued Christus Health in Corpus Christi, Texas. She claimed that while working as director of case management at Christus, she discovered patients undergoing a cardiac blockage removal procedure were routinely billed as inpatient when they should have been billed as outpatient. She alleged top hospital executives ignored her concerns about the billing issue before she resigned from Christus in 2007.
About four years after Ms. Guardiola filed the lawsuit, Christus settled with the Department of Justice for $5.1 million. Ms. Guardiola collected $1.02 million from the settlement, according to the report.
Ms. Guardiola was named director of clinical documentation at Reno, Nev.-based Renown Health in June 2009. She resigned in January 2012 and filed a qui tam lawsuit against Renown that same year. Ms. Guardiola claimed she faced "cultural and systemic resistance" from management after she alleged Renown was overcharging Medicare. Renown agreed to settle the false claims allegations in June 2016 for $9.5 million. Ms. Guardiola collected $1.7 million from the settlement.
Ms. Guardiola began working at Phoenix-based Banner Health in October 2012 as director of corporate documentation. She resigned three months later and filed a qui tam suit against Banner. In April, Banner agreed to pay the federal government more than $18 million to resolve allegations that 12 of its hospitals in Arizona and Colorado submitted false claims to Medicare. Ms. Guardiola will be paid $3.3 million of that settlement, according to the report.
Due to her history of filing whistle-blower lawsuits, Ms. Guardiola is "virtually unemployable," Mitch Kreindler, an attorney who has represented her, told The Republic. "She was always someone whose resume was hotly sought-after. Now, after maybe an initial phone interview, once they start doing their background checks, the communications dry up quickly."
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