The Wyoming Medical Center whistleblower lawsuit, filed by employee Gale Bryden, accuses records clerks of changing the admission statuses of patients from “outpatient” to “inpatient” without a doctor’s order. The change allowed the hospital to seek higher reimbursements from federal insurance programs, ranging from $35 to $1,100, the lawsuit says. 

Billing clerks are not allowed to alter the admissions status of patients, and generally, medical records are finalized when a patient is discharged. The whistleblower lawsuit, however, claims workers retroactively made changes to patient records.

Bryden says she suspected the practice continued even after she notified top hospital administrators in the fall of 2006, including the chief operating officer at the time who is now the hospital’s president. Bryden, who was responsible for collecting fees that had been denied by insurers, filed the whistleblower lawsuit on behalf of the federal government in October 2007. She says she became aware of the suspected fraud while serving on a hospital committee that discussed the admission status of patients. Bryden claims in the whistleblower lawsuit that she observed workers submitting claims to insurers that differed from the services the hospital actually provided.

An attorney for the Wyoming Medical Center denies there was any attempt by the hospital to defraud the government or private insurers, and says if mistakes did occur, they were inadvertent or accidental.

Despite admitting no wrongdoing, the hospital is reportedly working on a settlement for the case. If one is reached, and the federal government joins the case, Bryden stands to receive up to 30 percent of any recovered funds under federal whistleblower law.  The law is designed to encourage individuals with proof that their employer is defrauding the government to sue their employer on the government’s behalf.