Judith King is a nurse whistleblower who brought a qui tam lawsuit under the False Claims Act, alleging that Sharp Memorial Hospital defrauded Medicare through fraudulent reimbursement claims tied to its heart and kidney transplant centers. King was a registered nurse and heart transplant coordinator at Sharp Memorial Hospital in San Diego. Sharp agreed in March 2003 to pay $6.2 million to the federal government to settle the nurse’s whistleblower case.
Below is an excerpt from a story about King that ran in the Report on Medicare Compliance on March 13, 2003.
Judith King, a registered nurse, was a heart transplant coordinator at Sharp Memorial Hospital in San Diego. Phillips & Cohen brought a qui tam whistleblower lawsuit against her employer on her behalf, alleging the hospital had defrauded Medicare by filing fraudulent claims for reimbursement for costs associated with its heart and kidney transplant centers. Sharp agreed in March 2003 to pay $6.2 million to the federal government to settle the nurse whistleblower case. Below is an excerpt from a story about King that ran in the Report on Medicare Compliance (3/13/03).
Nurse whistleblower reports hospital manipulated cost-report logs
Apparently the reimbursement savvy of Sharp Memorial Hospital heart transplant coordinator Judith King was wildly underestimated, because when she raised concerns to her superiors about Medicare cost-report misallocations, she was brushed aside. Reimbursement rules are very complex, the veteran RN, was told, and you wouldn’t understand.
But King understood plenty. She’d attended lots of transplant conferences, which have their share of sessions on regulations and reimbursements, and kept her eyes and ears open. King was aware of a fundamental rule in the world of Medicare reimbursement as it applied to her transplant center: Medicare pays hospitals a DRG for transplants and follow-up care, so hospitals can bill additional fees only for certain pre-transplant services. She didn’t need an MBA to know the hospital allegedly was violating Medicare rules when it recouped 100 percent of the salaries of nurses and social workers even though they spent only a portion of their time on pre-transplant services.
Eventually King got fed up with the alleged cost-report shenanigans and management’s refusal to correct them. She became a nurse whistleblower and sued her San Diego employer under the False Claims Act, alleging cost-report fraud. The Justice Department took over the case. Sharp agreed to settle the false claims case last week for $6.2 million, though it denies wrongdoing. King, who has worked at the hospital for more than two decades, and her lawyers will collect $1.2 million of the settlement for their role in the case.
To get a copy of the entire story, please contact the Report on Medicare Compliance at www.AISHealth.com.
What nurse whistleblowers may report
Nurse whistleblowers may report suspected healthcare fraud, unsafe practices, patient neglect, retaliation, or other misconduct in a healthcare setting. In Judith King’s case, the alleged misconduct involved Medicare cost-report fraud tied to Sharp Memorial Hospital’s heart and kidney transplant centers.
| Issues nurses may report | Example |
|---|---|
| Healthcare fraud | Medicare, Medicaid, or government healthcare reimbursement fraud |
| False documentation | Inaccurate cost reports, altered records, or false billing support |
| Patient safety concerns | Unsafe practices, gross neglect, or dangerous working conditions |
| Retaliation | Termination, demotion, harassment, threats, or reduced responsibilities after reporting |
How should nurses report healthcare fraud or unsafe practices?
Nurses should document concerns carefully, preserve objective records, and consider speaking with legal counsel before reporting suspected healthcare fraud. Depending on the issue, a nurse may need to report concerns to a state or national regulator, OSHA, law enforcement, or pursue a False Claims Act qui tam case involving fraud against government healthcare programs. Internal reporting alone may not provide the same legal protections as reporting through the correct official channel.
What consequences can nurses face against whistleblowing?
Nurses who whistleblow about unethical or illegal practices in their workplace may face consequences such as retaliation, legal action, professional repercussions, psychological and emotional impact, and personal and financial costs. These consequences can include verbal or physical abuse, demotion, loss of job responsibilities, termination, defamation lawsuits, challenges to their reputation and credibility, stress, anxiety, depression, and financial burdens. It’s important for nurses to carefully consider the risks and benefits of whistleblowing and take appropriate steps to protect themselves, while organizations should have robust policies to support whistleblowers and address concerns in a fair and transparent manner.
What protections do nurse whistleblowers have?
Nurse whistleblowers may be protected by federal or state laws, depending on what they report and how they report it. Nurses who report healthcare fraud involving government funds may have protections under the False Claims Act, including anti-retaliation protections for lawful acts taken in furtherance of a False Claims Act case.
Should nurses report concerns internally before filing a whistleblower claim?
It depends on the facts, the employer, and the legal framework involved. Nurses should document concerns and consider legal counsel before taking action, especially when the issue involves healthcare fraud, retaliation risk, or government funds. ANA advises nurses to consult legal counsel or a state nurses association when possible before acting.
Can nurse whistleblowers receive rewards?
Nurse whistleblowers may receive rewards when they bring successful False Claims Act cases involving fraud against government programs. In Judith King’s case, she and her lawyers received $1.2 million from the Sharp settlement.
How Phillips & Cohen protects whistleblowers in nursing
Phillips & Cohen specializes in representing whistleblowers in nursing and healthcare fraud cases. We provide legal representation, whistleblower advocacy, confidentiality protection, legal expertise, and a supportive approach to nurses who wish to whistleblow on fraud in the healthcare industry. Our firm has a track record of successfully representing whistleblowers and takes measures to protect their confidentiality and rights throughout the legal process. Nurses considering whistleblowing or with concerns about healthcare fraud should seek legal counsel for guidance. Contact Phillips & Cohen for a free confidential case review.