Whistleblowers Earn Millions Turning in Medicare/Medicaid Scammers

What a coincidence!  Two stories came my way yesterday, one from Tennessee and the other from Pennsylvania, where whistleblowers filed cases against large companies they said were scamming the US taxpayers and were handsomely rewarded for their good work on our behalf.

The first story at the National Law Review is this one from Tennessee:

Tennessee-Based Health Services Company Settles FCA Case Alleging Medicaid Fraud For $9.5 Million

The Department of Justice (“DOJ”) announced another False Claims Act (“FCA”) settlement centered around a health services company’s practice of providing unnecessary therapy services to patients in order to receive the maximum amount of reimbursement under Medicare. The $9.5 million settlement is with Diversicare Health Services Inc, a Tennessee-based company that provides nursing and rehabilitation services at 74 locations throughout the country. Diversicare’s alleged violations are similar to those in a medicaid fraud case settled by the DOJ for $15.4 million two weeks earlier concerning fraudulent Medicare reimbursements for unnecessary rehabilitation services.

The settlement resolves two separate qui tam FCA lawsuits filed by whistleblowers Mary Haggard and Bryant Fitzmorris, both former Diversicare employees. Ms. Haggard will receive a whistleblower award of roughly $1.4 million, and Mr. Fitzmorris will receive $145,350. The FCA allows private citizens who possess inside information of fraudulently billing against the United States Government to initiate a lawsuit on the Government’s behalf to recover those funds. The citizens, known as qui tam relators, are then entitled to receive a share of any damages that the Government ultimately recovers from the litigation.

More details here.

Then from Whistleblower News Review (cool, a newsletter for whistleblowers) comes this story from Pennsylvania:

Guardian Elder Care Will Pay $15.4 Million to Resolve Allegations of Medicare Fraud – Whistleblowers Will Receive $2.8 Million

Guardian Elder Care Holdings Inc. and a list of related entities, including Guardian LTC Management and Guardian Rehabilitation Services (collectively, Guardian), have agreed to pay $15.4 million to settle a False Claims Act lawsuit. According to the complaint, Guardian billed government healthcare programs for medically unnecessary services. The company allegedly defrauded both Medicare and the Federal Employees Health Benefits Program.

Guardian is headquartered in PA. https://www.phillyvoice.com/guardian-elder-care-nursing-home-unnecessary-rehab-therapy-settlement/

Pennsylvania-headquartered Guardian operates over 50 nursing facilities in Pennsylvania, Ohio, and West Virginia. According to the whistleblower lawsuit filed by two rehab managers who worked at a Guardian facility in Carlisle, Guardian caused some of its facilities in all three states to bill the government for medically unnecessary services, at the highest level of Medicare reimbursement, solely to maximize profits.

The whistleblower complaint resolved by the $15.4 million settlement was filed under the False Claims Act (“FCA”). Under the FCA, whistleblowers with original information about a fraud can come forward and become eligible for an award ranging between 10 and 30 percent of any resulting recovery. The two whistleblowers in this case, Philippa Krauss and Julie White, will share a $2.8 million award.

More here.

How many more companies are ripping off US taxpayers via Medicare and Medicaid fraud?  I bet a lot.  So if you work for one and suspect fraud, check into becoming a whistleblower—it is the patriotic thing to do!

I have a bunch of posts about other successful whistleblowers, see here.

 

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