Lawsuit accuses Roseland Community Hospital, fired doctor of fraudulent billing related to COVID testing
CHICAGO (CBS) -- A lawsuit has issued serious claims of fraud against Roseland Community Hospital in the city's Far South Side – centered around COVID-19 testing.
As CBS 2's Jermont Terry reported Friday night, a whistleblower accuses the hospital of running up insurance bills, and raking in millions.
For more than a year, federal investigators kept documents in this case sealed – until Friday. A fired doctor whose sole job was to oversee COVID testing, along with a Roseland hospital executive, are accused of deliberately defrauding taxpayers and insurance companies for profit.
During the height of the COVID-19 pandemic, health facilities scrambled to meet the demand for testing. On the Far South Side at the time, we saw people standing in long lines at Roseland Community Hospital.
Now, two years later, the whistleblower claims the hospital "billed for services related to COVID-19 testing that were never provided."
The newly-unsealed complaint was filed by Elio Montenegro, who is an "employee of Roseland where he works as the Senior Director of Development." The whistleblower worked directly with hospital leaders back then, and still does today.
The 25-paghe complaint accuses a now-fired employee - "Dr. Terrill Applewhite, an independent contractor, who worked as Medical Director overseeing the hospital's COVID-19 response."
The suit says Applewhite and his company, along with the hospital, "knowingly and intentionally submitted false claims for payment."
Instead of testing only for COVID, the federal suit says insurance companies and the government were "billed for a "full panel" of blood tests" – resulting in unnecessary charges and bills.
How much are we talking? According to the complaint, the doctor and the hospital "billed for approximately 20,000 to 25,000 patients visits," resulting in "between $2.8 and $3.6 million in fraudulent billing."
The whistleblower said when he informed the hospital, the doctor was fired. Btu the suit claims,
"Roseland never disclosed these false billings to any government agency or private insurer."
And when the whistleblower brough the concerns directly to hospital executives, the suit claims hospital leaders said, "it was so Roseland could earn more profits."
But an attorney for Roseland Community Hospital issued a statement denying that the hospital or its chief executive officer, Tim Egan, were involved in anything improper:
"Mr. Egan and Roseland Hospital share the Relator's concern with improper third-party billing and services. Unbeknownst to Mr. Montenegro, for more than a year, Mr. Egan has been sharing information on a confidential basis with federal investigators into Dr. Applewhite. Mr. Egan completely denies any insinuation by Mr. Montenegro that he or Roseland Hospital were involved in any improper behavior."
The whistleblower did not want to talk directly to us about the lawsuit. But Roseland Community Hospital insisted they hid nothing from federal investigators.