Medicare False Claims Whistleblower To Receive $15M

162017_132140396847214_292624_nAn Alabama nurse will receive $15 million as her share of the settlement proceeds from a False Claims Act whistleblower lawsuit she filed against her former employer, a Louisiana-based home healthcare company that operates in 37 U.S. states. Her former employer has agreed to pay $150 million to the U.S. government to settle claims that it submitted false home healthcare billings to the Medicare program.

The nurse had filed her federal False Claims Act lawsuit in Birmingham, Alabama in 2010, which was later consolidated with six other whistleblower lawsuits filed against the same employer, in federal court in Pennsylvania.

The nurse, who was providing home healthcare services on behalf of her employer, alleged that her employer was requiring her and other nursing and therapy providers employed by the company to bill for home health services that were not being provided or were not medically necessary, to ineligible patients for ineligible services, such as those who were not homebound.

According to reports, the nurse claimed that employees were required by their employer to use electronic billing forms that were always coded to bill for the highest level of service, which did not reflect the true level of service provided or the true condition of the patients, thereby resulting in false claims being submitted to Medicare and the employer receiving higher reimbursements from Medicare than it was entitled to receive.


The nurse alleged that she was fired after she raised questions with her employer regarding the practice. Her False Claims Act lawsuit (known as a qui tam action) was the first of seven to be filed throughout the United States against the same home healthcare company for alleged improper billings between 2008 and 2010. The federal lawsuits were sealed until the settlement was announced on April 23, 2014. The whistleblowers will share in over $26 million, of which the Alabama nurse will receive $15 million.

The settlement also involves allegations that the home healthcare company maintained improper financial relationships with referring physicians in violation of the Anti-Kickback Statute and the Stark Statute that restrict the financial relationships that home healthcare providers may have with doctors who refer patients to them. It was alleged that the company had an improper financial relationship with a private oncology practice in Georgia, whereby the company’s employees provided patient care coordination services to the oncology practice at below-market prices.

The False Claims Act provides an incentive to whistleblowers who bring lawsuits on behalf of the United States to recover wrongful payments under specified circumstances. If the U.S. Attorney’s Office investigates and intervenes in their federal lawsuits and there is a recovery of money by settlement or judgment, the False Claims Act provides for payment of a portion of the recovered money to the whistleblowers.


If you have knowledge of false billings sent to Medicare for payment/reimbursement, you may become a whistleblower and if your whistleblower claim/lawsuit results in a settlement or judgment with the wrongdoer, you may be entitled to share in a portion of the amount recovered.

Click here to visit our website or call us toll-free at 800-295-3959 to be connected with whistleblower attorneys (false claims lawyers or qui tam lawyers) in your state who may assist you with your whistle blower claim.

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This entry was posted on Thursday, May 1st, 2014 at 9:59 am. Both comments and pings are currently closed.


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