Whistleblowers continue to find success by using the False Claims Act to report health care fraud, enabling government attorneys to pursue companies and individuals for damages for Medicare fraud — and financially rewarding the whistleblowers who took the initiative to report the improprieties. A recent nursing home settlement from Tennessee provides a good example.
A former employee of a nursing home company filed a lawsuit under the whistleblower provisions of the False Claims Act, alleging that the ex-employer, Grace Healthcare, provided unnecessary therapy services to 10 of its facilities in order to increase the amount it could submit to Medicare for reimbursement.
According to the suit and to the government’s findings, revenue goals from Medicare by the company were established without concern or regard for the patients’ need for them. In this way, the company was allegedly able to pad its profits at taxpayer expense. These practices allegedly went on between 2007 and 2011.
As a result of the qui tam lawsuit, the nursing home operator, Grace Healthcare agreed to pay $2.7 million in settlement to resolve the allegations; of that, $405,000 is set to go to the whistleblower in the case, who was not identified.
The whistleblower provisions of the False Claims Act continue to reap big settlements for the government and the whistleblowers who point out wrongdoing in nursing homes and health care generally: more than $10 billion has been recovered to resolve allegations of health care fraud in just the last four years. Employees who find themselves mulling a whistleblower claim can consult with attorneys who specialize in False Claims Act lawsuits.
Source: Legal Newsline, “Nursing home to pay $2.7M for False Claims Act violations,” Stephanie Ostrowski, March 25, 2013