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Oct 18, 2021 by |

Napa County Whistleblower Attorney: $360,000 Settlement of False Claims Act Allegations Of Overbilling By Nursing Home


Allegations Of Overbilling And Upcoding

Unnecessary Therapy Services Covered By Medicare<h2>

Former Employee Blows Whistle

Medical fraud makes up over three quarters of the annual recoveries for the government under the False Claims Act (FCA), 31 U.S.C. § 3729 et seq.   Over two thirds of the $2.2 billion recovered in 2020 came from cases brought by individual and there have been multiple large cases just in 2021 that demonstrate the FCA’s continued effectiveness. Cases under the FCA can capture and prosecute massive fraud and smaller cases. private individuals are authorized to bring whistleblower suits (known as qui tam cases).  Private parties bringing the qui tam suits under the FCA to help the government, through the U.S. Department of Justice (DOJ), recover money paid out on fraudulent claims are referred to as “relators” commonly known as whistleblowers, who recover anywhere from 15% to 30% of the damages and penalties or settlement once the government recovers. 31 U.S.C. § 3730(d).  If you have credible information of fraud against the government in Napa County, San Francisco, 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).

Recent Settlement Of Overbilling Allegations Against Nursing Home

The DOJ recently announced a settlement with a skilled nursing facility[1] resolving allegations that it violated the False Claims Act by providing unnecessary and “upcoded” physical, occupational, and speech therapy services to increase Medicare payments.  A consent judgment and settlement agreement resolved allegations that, from 2008 to 2016, the skilled nursing facility provided medically unnecessary services to Medicare beneficiaries, first through a third-party skilled therapy vendor and then through its own skilled therapy affiliate.  The allegations contend that the nursing home pressured others to meet quotas for the proportion of Medicare Part A beneficiaries utilizing the highest-possible reimbursement level, known as the Resource Utilization Group (“RUG”) score, in an effort to increase Medicare payments.  The home also allegedly claimed payment for therapy services without a physician order and other times reported that skilled therapy had been provided, when, according to the complaint, the patients were not participating in therapy or were unable to undergo or benefit from it.  Previously, the government reached a settlement with the therapy vendor and its owner, requiring them to pay $1.09 million to resolve alleged False Claims Act violations.

Fighting Against Employer Retaliation

A former employee of the therapy services provider brought the qui tam case, and the government elected to intervene.  The FCA protects employees against retaliation from their employers for blowing the whistle on fraud against the government, 31 U.S.C. § 3730 (h), but despite the legal prohibition employers continue to retaliate against whistleblowers.  If you are demoted, transferred or fired because you brought any fraud to light, 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 healthcare fraud in Napa County, San Francisco or elsewhere in California, call Ingrid M. Evans at (415) 441-8669, or toll-free at 1-888-50EVANS (888-503-8267) or by email at <a href=””></a>.  In addition to FCA whistleblower cases, Ingrid also handles 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. was not involved in the case in any way. 

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