ATTORNEY NEWSLETTER
Inappropriate Hospice Certifications Possible Fraud
Four Former Employees Blow Whistle
Healthcare fraud against the government includes kickbacks, false billing, upcoding, sales of unapproved drugs, illegal referrals and kickbacks, and inappropriate certifications for services like hospice care. Individuals can bring whistleblower cases under the False Claims Act (also known as qui tam cases) on behalf of the government to recover money paid out as a result of such fraud, and receive up to 15-30% of what the government recovers as a reward. 31 U.S.C. § 3730(d). The California whistleblower/qui tam attorneys at Evans Law Firm, Inc. represent individuals with credible information of any type of fraud against the government, including healthcare fraud. If you have credible information for a whistleblower or qui tam case, call the whistleblower/qui tam attorneys at Evans Law Firm Inc. today at (415) 441-8669.
False certifications for government reimbursed services are one instance of healthcare fraud identified in whistleblower cases. In U.S. ex rel Drudging, et al. v. Care Alternatives, No. 18-3298, 2020 WL 1038083 (3d Cir. Mar. 4, 2020), the Third Circuit Court of Appeals recently upheld the right of four former hospice employees to proceed with whistleblower allegations that their employer falsely certified patients for hospice care in order to receive government reimbursement under Medicare.[1] Conflicting expert testimony had been presented in the case about the patients’ eligibility. Defendant argued the difference of opinion proved there was no objective falsity. The Third Circuit rejected that standard found that the difference of medical opinion meant that that the “falsity” of the claims was a triable issue.
Under Care Alternatives whistleblowers would not need to show objective falsity in order to proceed with their claims in these types of cases; disputing expert opinion would be enough to survive a summary judgment motion by defendant on the issue. The decision represents a victory for qui tam plaintiffs in cases where the medical necessity of a reimbursed procedure or service is the central issue.
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If you or a loved one has information regarding a whistleblower or qui tam case of false claims for Medicare and Medicaid reimbursement, or bank fraud under The Financial Institutions Reform, Recovery, and Enforcement Act of 1989 (FIRREA/FIAFEA), securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, other False Claims Act cases, the Internal Revenue Service Whistleblower Office, the FINRA Whistleblower Office or the California False Claims Act, contact Ingrid M. Evans and the other California whistleblower attorneys at Evans Law Firm, Inc. at (415) 441-8669, or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. If your employer retaliates against you for blowing the whistle on fraud, our litigators can also represent you in any action for wrongful termination. Remedies include reinstatement, double back pay plus interest, special damages, and attorneys’ fees and expenses incurred in bringing your case. 31 U.S.C. § 3730(h)(2).
Our attorneys have experience with large whistleblower cases, complex financial contract litigation, and large insurance companies. We can help guide your case through whistleblower false claims applications, discovery and investigation, a jury trial or toward an equitable settlement. We also handle cases involving physical and financial elder abuse, nursing home abuse, whole life insurance and universal life insurance, and indexed, variable, and fixed annuities.
[1] Evans Law Firm, Inc. was not involved in the case in any way.
