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‘Compliance professional’ collects third whistleblower award

A registered nurse and lawyer who served in compliance roles for healthcare providers was awarded $3.3 million in a False Claims Act settlement. She has now collected more than $6 million in three separate qui tam actions against former employers.

Cecilia Guardiola worked less than three months as corporate director of clinical documentation for Banner Health in Arizona. She resigned in December 2012 and filed a lawsuit in 2013.

Banner Health settled the case last week for over $18 million, the DOJ said last week. Guardiola’s share is at least $3.3 million.

Guardiola was also the plaintiff in two earlier False Claims Act suits against healthcare companies she worked for, according to Health Leaders media.

In each case, she alleged her former employers were overbilling for medical services.

The whistleblower provisions of the False Claims Act allow private citizens to sue on behalf of the government and share in any recovery.

In 2016, Guardiola collected $1.7 million when Renown Health agreed to pay the federal government $9.5 million for an FCA settlement.

She worked for Renown in Nevada for about 19 months, Health Leaders media said.

Guardiola served as director of clinical documentation and then as director of clinical compliance.

“She resigned in January 2012 and filed a lawsuit within five months,” the report said.

Her lawyers in the Renown Health case said in a July 1, 2016 release,

Guardiola is a registered nurse, compliance professional and law school graduate with extensive nursing and compliance experience. She was hired by Renown Health in 2009 as Director of Clinical Documentation. Her role was to improve the quality of medical documentation in each patient’s record to support improved billing. As her efforts brought higher revenues to Renown Health and her responsibilities increased, she was promoted to Director of Clinical Compliance.

In 2012, Guardiola collected about $1 million when Christus Spohn, a non-profit health system in Texas, agreed to pay the federal government more than $5.1 million to settle her False Claims Act suit.

Guardiola worked for Christus Spohn for about 16 months as director of case management, Health Leaders media said.

She resigned in 2007 and filed her qui tam lawsuit in 2008.

Christus Spohn also agreed to pay more than $145,000 to cover Guardiola’s legal fees, the report said.

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Richard L. Cassin is the publisher and editor of the FCPA Blog.

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