Two Nurse Whistleblowers Receive $350,000 for Reporting False Claims Act Violations in form of Medically Unnecessary Services by Hospice Providers

Our Los Angeles Whistleblower Attorneys report another multi-million dollar settlement for alleged violations of the False Claims Act (“FCA”).  Between 2005 to 2011, several nursing homes and hospice care facilities admitted patients who did not actually need hospice care.  In turn, the facilities billed Medicare for the medically unnecessary services.  They were able to do so by providing kickbacks to certifying physicians who unlawfully designated the patients as having the diagnosis of “debility” and the need for hospice care.  Instead, these patients were suffering from chronic conditions but were not terminal pursuant to hospice requirements.  The Department of Justice agreed with the settlement for $4.4 million dollars to resolve the claims.

As such, two nurses observed these practices and courageously worked with their attorneys to file the FCA allegations with the government and court under seal.  Their names remain anonymous.  Admitting patients for terminal conditions when no such conditions exist is a major FCA government healthcare program fraud violation since Medicare and Medicaid (or Medi-Cal in California) have to then pay for these services.  Federal healthcare programs are funded by taxpayers and when they are defrauded this not only hurts the taxpayers but also those patients who truly need and require the healthcare benefits and services.   In addition, when doctors receive kickbacks in the form of any benefit, they are held to Stark Law violations and may lose their license.  The facilities involved would be in violation of Anti-Kickback Statute and FCA laws.

Under the FCA, the Judge is entitled to order the defendant to pay triple the actual damages that the jury finds.  In addition, the FCA also permits statutory penalties from $5,500 to $11,000 for each false claim submitted by the defendant.  As result, the whistleblower will receive approximately 15 to 25 percent of the total FCA recovery plus attorney’s fees.

As the main enforcement arm of the federal government, the Justice Department reviews all cases filed under the FCA.   Then, once the whistleblower case is assessed, the government decides whether it will prosecute or allow the whistleblower to bring the complaint on the government’s behalf.

The FCA is used to stem out fraud related to billing, staffing, and kickbacks. Examples of these are when financial companies are supposed to abide by state and federal laws and chose to ignore them.  They also bills for services that were not provided or the bill was submitted at an improperly higher rate of reimbursement for the services.  In addition, financial companies are often fount to illegally bill the government for substandard services by fraudulently certifying otherwise. Alternatively, these companies may realize that they have credit from their services that they have to repay to the government, but the companies do not reimburse the government within the 60 day time frame.  See these blogs for more examples of the FCA.

If you witness any potential false claims in California (i.e. requests for reimbursement to the government, not actually rendering work when reimbursement is received, or receiving and knowingly retaining an overpayment) by your company, or you are retaliated against for voicing your concern about potential wrongdoing, immediate action is vital.  Contact the experienced employment law attorneys at Stephen Danz & Associates for a free consultation to discuss your circumstances and legal options.