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Jan 28, 2021 by |

Santa Clara County and California False Claims Whistleblower Attorney: Illegal Kickbacks Allegedly Paid By Home Health Care Agency

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Health care fraud against Medicare and other government health care programs is the largest source of fraud against the government and ultimately taxpayers. Individuals who blow the whistle on such fraud can be rewarded under the False Claims Act (FCA), 31 U.S.C. § 3729 et seq., for their efforts when the government recovers from the wrongdoers. 31 U.S.C. § 3730(d).  Whistleblower cases under the FCA are known as qui tam actions and are brought in the federal court usually in the district where the fraud occurred.  The attorneys at Evans Law Firm, Inc. represent whistleblowers in FCA qui tam cases who have firsthand information of overbilling, false certifications, reimbursement for unapproved medications and devices, miscoding procedures, or paying illegal kickbacks to physicians or others for provision of medical services.  If you have credible information of fraud against the government that may be the basis for a whistleblower or qui tam case, call the Santa Clara County and California whistleblower attorneys at Evans Law Firm, Inc. today at (415) 441-8669.

Home Health Care Agency Case

In a recently reported settlement of an FCA case[1] a home health care agency and two of its executives have agreed to pay $5.15 million to resolve allegations that the agency provided improper financial inducements to referring physicians through sham medical director agreements and bonuses.  According to a press release from the Department of Justice, the agency will pay $3,856,000 to settle the allegations and an additional $675,000 to resolve separate allegations that employees pressured clinical personnel to increase the number of home visits for Medicare patients to avoid the Medicare Low Utilization Payment Adjustment that would have decreased the reimbursement the agency receives from Medicare.  The settlement resolves allegations that defendants violated the Anti-Kickback Statute (42 U.S.C. § 1320a-7b) and the Stark Law (42 U.S.C. § 1395nn (“Limitation on certain physician referrals”))[2], by entering into sham medical director agreements with physicians as a means of providing remuneration for referrals and by providing bonuses to employees based on those referrals. The agreement also resolves allegations that the agency provided unnecessary services to Medicare patients to increase the number of skilled service visits provided during a home health episode to avoid the Low Utilization Payment Adjustment, which otherwise would have decreased Doctor’s Choice Medicare reimbursement. The former employees who blew the whistle on the fraudulent schemes and kickbacks will receive a reward.

How Qui Tam Cases Begin

Qui tam cases begin with original and credible information of false claims and include hard documentation and other evidence supporting that information.  The litigators at Evans Law Firm know how to frame your evidence into a complaint.  The complaint is filed under seal in the federal court.  The seal period lasts 60 days during which the government investigates your claims.  (If necessary, the government can, and often does, extend the 60-day period during which the allegations are kept under seal.)  Employers are prohibited from retaliating against you for bringing a FCA qui tam case, and your complaint can include claims that the defendant unlawfully retaliated against you.  31 U.S.C. § 3730.

Contact Us

If you have credible information of any kind of healthcare fraud against the government, contact Ingrid M. Evans and the other Evans Law Firm whistleblower and qui tam attorneys at (415) 441-8669, or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. Ingrid and the other whistleblower attorneys at Evans Law Firm also handle bank fraud whistleblower cases under the Financial Institutions Reform, Recovery, and Enforcement Act (FIRREA), commodities and futures trading cases under the Commodities Futures Trading Commission Whistleblower Program, securities fraud cases under the Securities and Exchange Commission Whistleblower Program and FINRA Whistleblower Office and offshore tax evasion and other tax fraud cases under the Internal Revenue Service Whistleblower Office. 

[1] Evans Law Firm, Inc. was not involved in the case in any way.

[2] The Anti-Kickback Statute prohibits the offering or payment of remuneration to induce or reward referrals for services paid for by federal health care programs. The Stark Law forbids certain medical providers, including home health agencies, from submitting claims to Medicare for services provided to patients who were referred by a physician with whom the provider has a prohibited financial relationship, unless that relationship falls within an applicable exception.

 

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