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Jul 3, 2021 by |

California And Alameda County Whistleblower Attorney: $129 Million Medicare Whistleblower Suit Unsealed

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Allegations Of Overbilling By Nursing Home Chain

Government Intervenes In Suit Alleging Ten Years Of False Claims

Medicare Fraud Allegedly Exceeds $129 Million 

Medicare and Medicaid fraud cost the government and taxpayers billions every year.  In fact, healthcare fraud is the largest source of fraud against the government.  According the Centers for Medicare & Medicaid Services reports that improper payments totaled $25.74 billion in 2020 alone.  The primary anti-fraud enforcement statute against companies who defraud the government  is the False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq.  Individuals can bring FCA actions on behalf of the government; the actions are known as “qui tams” and the plaintiffs are referred to as “relators.” 31 U.S.C. § 3730(b).  A qui tam action is filed under seal and remains under seal until the government investigates the case; at the end of the seal period the suit is made public.  Healthcare fraud actionable under the FCA includes overbilling, selling unapproved drugs or medical devices, false certifications and eligibility records or billing for services that were never provided.  Individuals with knowledge of illegal kickbacks can be rewarded for bringing suit against the offending companies who defraud these programs. If you have credible information of Medicare fraud, illegal kickbacks or other healthcare fraud in Alameda County or elsewhere in California, call us today at (415)441-8669 and we can help. Our toll-free number is 1-888-50EVANS (888-503-8267).

Skilled Nursing Facility Alleged Overbilling

In a recent unsealing of a qui tam action announced by the U.S. Department of Justice,[1] a qui tam case against a major group of skilled nursing facilities and its owner has become public, alleging Medicare fraud exceeding $129 million.   The case alleges that eleven skilled nursing facilities, their management company, owner, and a senior employee fraudulently billed Medicare for over a decade for unnecessary services.  The DOJ’s lawsuit carries forward claims developed by the relator through its extensive investigation and data analysis of the Medicare billing practices of the eleven nursing homes.  The complaint alleges that these defendants were engaged in significant Medicare fraud through wrongfully extending patient stays and providing unnecessary and unreasonable rehab without regard for patients’ medical needs.  The original suit was filed under seal in 2017.  Following its own investigation of the original allegations, the DOJ filed its own complaint-in-intervention alleging that the very schemes identified by the relator continued after the filing of the original suit.  Thus, the government alleges that for a full decade, the Defendants allegedly kept Medicare patients at the facilities longer than reasonable or necessary, and put those patients on higher levels of rehabilitation therapy than reasonable or necessary. According to the government these practices were designed to increase the amounts billed to Medicare beyond what was justified based on patients’ clinical needs. In some instances, the facilities allegedly went so far as to intentionally limit patients’ progress in order to create the appearance of a continued need for services.

How Relators Are Rewarded

Although the relator in this case was an analytic company, often employees are the individuals who have the original information of the fraud. Current employees, agents, executives, officers, and others are protected from employer retaliation for bringing false claims qui tam cases. 31 U.S.C. § 3730(h).  If you are fired because you brought any fraud to light, you can fight back under the False Claims Act which prohibits retaliation against you for exposing the wrongdoing.  You may be entitled to sue your employer in court  and seek double back pay (with interest), reinstatement, reasonable attorneys’ fees, and reimbursement for certain costs in connection with the litigation. 31 U.S.C. § 3730(h)(2). Evans Law Firm, Inc. can represent you in any action for retaliation as well as represent you in your underlying whistleblower application.

Contact Us

If you have credible information of government contractor fraud against Medicare or Medi-Cal call Ingrid M. Evans at (415) 441-8669, or toll-free at 1-888-50EVANS (888-503-8267) or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>.  In addition to FCA and CFCA whistleblower cases, Ingrid and Evans Law Firm, Inc. also handle bank fraud whistleblower cases under FIRREA/FIAFEA, commodity trading and securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, and tax fraud under the Internal Revenue Service Whistleblower Program. 

[1] Evans Law Firm, Inc. is not involved in the case in any way. The qui tam case is captioned U.S. ex rel. Integra Med Analytics LLC v. Isaac Laufer, et al., Case No. 17-cv-9424 (S.D.N.Y.).

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