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.


Duke University Ordered to Repay the Federal Government (you!) $112 Million for Grant Fraud

It looks like all involved are Americans (LOL! I am, after all, fair and balanced here at Frauds and Crooks!).

I’m stuck with posting a photo of the university since I could not find a photo of the researcher who lied or the whistleblower who is now rich!

But, I’m bringing you this news for several reasons and first and foremost I want you to know that a whistleblower filed a lawsuit that provided information about how research data was being fudged (for years!) and has been awarded $33 million as a reward under the False Claims Act.
Good for him!
So keep an eye on possible opportunities for you to turn in someone or some institution that is defrauding Uncle Sam!  
Continue reading “Duke University Ordered to Repay the Federal Government (you!) $112 Million for Grant Fraud”

Corporate Whistleblower Center Looking for Partners

How cool is this!  The entrepreneurial spirit is alive and well!
Regular readers know that I’ve been telling you about scams involving Medicare and Medicaid that are often perpetrated through long term care facilities for the elderly or disabled.

Nursing home fraud on the rise:  http://civil-law.com/blog/nursing-home-fraud-studies-expose-little-known-risk/

And, I’ve told you that if you help the government find the fraud, you can make money if the government recovers funds stolen from taxpayers.
Now here comes a group banding together to go after this fraud with the lure of making money AND making yourself such a hero you could run for Congress!
That last part made me laugh because I’ve said on previous occasions that one could craft a whole campaign for elected office around the goal of exposing fraud, waste and abuse involving taxpayer dollars.
From PR Newswire,

Corporate Whistleblower Center Now Goes After Nursing Homes Ripping Off Medicare/Medicaid From California to Florida for Whistleblower Rewards and a Physician or Investor is Invited to Participate as a Partner-Become a Local Hero-Make Money


The Corporate Whistleblower Center says, “We have just launched our most ambitious initiative ever to go after nursing homes, skilled nursing facilities, rehab centers and or acute care facilities that are overbilling Medicare or Medicaid for services that were never performed, and we need some financial partners in some specific states. When we say ‘services never performed’ we are referring to facilities that are so understaffed their patients are prematurely dying. Short staffing is the foundation and starting point for our state specific whistleblower reward initiatives. While these types of healthcare facilities might be extremely understaffed-they are billing Medicare or Medicaid as if they are fully staffed.
“We are inviting a successful physician, dentist or an investor in one of our targeted states such as California, Florida, Pennsylvania, Illinois or Ohio to financially participate in this venture and to share in the whistleblower rewards. A medical doctor/dentist or investor who financially participates with us in one of the states we have mentioned could probably run for Congress in a couple years after the notoriety they will gain for their participation in our initiative as we would like to discuss with them anytime at 866-714-6466. We also want to emphasize this initiative is very focused on making certain our financial partners make money.”

Go here for more to see additional states the group plans to target!
Of course, I am not advocating for this new ‘business’ model just bringing you news you might find of interest.

question markYou know what you need to do, right!—keep an eye on granny (or any family member) who resides at a long term care facility to assure that they are being cared for properly and that there is no financial funny-business going on with Medicare or Medicaid. Report suspicions of fraud or medical abuse!


Feds Recover $2.5 Billion from Health Care Industry Fraud in 2018

That is just the money recovered in successful health care fraud cases. Imagine how much more goes undetected!
Justice Dept. logo
Here is the news of the Department of Justice’s annual report for 2018 for legal judgements under the federal False Claims Act. (Fascinating! the Act has been around since the Civil War.)
I know this might sound pretty boring, but you need to know about it especially as some of the successes come from “whistleblowers” who are able to make some serious money while unearthing fraud in primarily (in this case) the health care sector.
So, if you work for a doctor or hospital and notice some strange financial transactions, or see something suspicious on your Medicare statements, keep this in mind!
From a report by the law firm Holland & Knight:

In December 2018, the U.S. Department of Justice (DOJ) released its annual statistics for its civil False Claims Act (FCA) and fraud cases from the fiscal year ending Sept. 30, 2018 (fiscal year 2018). The DOJ reports it recovered $2.8 billion in settlements and judgments for Fiscal Year 2018. Of the $2.8 billion recovered in fiscal year 2018, $2.5 billion involved the healthcare industry—the ninth consecutive year that the DOJ’s civil health care fraud settlements and judgments have exceeded $2 billion.
qui tam suits
….the FCA is used by the U.S. government to combat healthcare fraud and also serves as the primary civil remedy for redressing false claims involving federal government contracts, grants, and federally-funded programs.
FCA cases can originate in one of two ways: (1) actions brought by the DOJ, or (2) actions brought by whistleblowers, known as relators, who are entitled to a portion of any proceeds recovered through settlement or judgment. In the latter actions, called qui tam actions, the case is filed under seal and the DOJ is given a period of time to evaluate the allegations and decide whether to intervene (i.e. take over the case). If DOJ declines to intervene, the relator may proceed with the action and potentially receive a greater cut of the recovery.
…in the healthcare industry newly brought qui tam cases are down while non-qui tam cases are slightly up.
The increase in government-initiated healthcare cases may be attributable to enforcement initiatives such as the nationwide Medicare Strike Force Teams. These teams, which are scattered throughout the United States, focus on criminal and civil health care fraud.

Feds are increasing the number of US Attorneys in key hot spots!


The trend line for government-initiated FCA actions should increase over the next few years. DOJ recently added a cadre of new affirmative civil enforcement attorneys, whose role will include initiating cases under the FCA. The new Assistant United States Attorneys (AUSAs) are being placed throughout the country—and offices where there is a hotbed of government contracting and healthcare are receiving more than one new AUSA. While most U.S. Attorney’s Offices will receive one additional AUSA for affirmative civil enforcement, DOJ announced that offices such as Colorado, Middle District of Florida, Southern District of Florida, Massachusetts, New Jersey, Eastern District of New York, Southern District of New York, and Eastern District of Virginia, would receive two.

More here.

question markThis got me thinking.  Have you seen any funny money business going on with the US Refugee Admissions Program and the Dept. of Health and Human Services contractors?
If so, think about this avenue to bring attention to possible fraud! You might actually make a few bucks in the process!

Afterthought:  I need to be sure to let new readers know why I write this blog, here is my “welcome” post from January first.