ATTORNEY NEWSLETTER
Allegedly Submitted Claims For Unqualified Patients
Former Travel Nurse And Director Bring Suit
$700,000 In Rewards To Whistleblowers
Private citizens and businesses help the government recover billions every year in cases of fraud against the government. The private citizens and businesses assisted the government in recovering these funds by bringing civil lawsuits on behalf of the government under the False Claims Act, (“FCA”), 31 U.S.C. § 3729 et seq. The private individuals or businesses bringing the actions are known as “relators,” and the cases themselves referred to as “qui tam” cases. If the government recovers, the relators are eligible for rewards. 31 U.S.C. § 3730(d). The majority of qui tam cases filed annually concern fraud in the healthcare sector, where Medicare or Medicaid funds have been paid out on false claims. Relators of fraudulent conduct are often former employees, accountants, controllers, directors or managers, or competitors of the business engaging in the fraud. If you have credible information of fraud against the government in violation of the FCA in 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[1]
The U.S. Department of Justice (DOJ) recently announced that a provider of home health care and hospice services has agreed to pay $3,850,000 to resolve allegations that it violated the False Claims Act in connection with two lines of its business: first, that it knowingly submitted claims to Medicare for home healthcare services for patients who did not qualify for the Medicare home healthcare benefit or where services otherwise did not qualify for Medicare reimbursement; and second, that it knowingly submitted claims to Medicare for patients who did not qualify for the hospice benefit.
The United States alleged that, between 2016 and 2021, 19 of defendant’s facilities submitted claims to Medicare for home healthcare services for patients who did not qualify or were not properly certified as eligible for the Medicare home healthcare benefit, where the services provided were not reasonable or medically necessary, where the services were provided by untrained staff, or where services were not performed. Separately, the United States alleged that, between 2016 and 2021, three company hospice facilities admitted patients to hospice care who were ineligible for the Medicare hospice benefit because they were not terminally ill or continued providing services to patients who should have been discharged because they no longer met the requirements for the Medicare hospice benefit.
“Medicare’s hospice and home healthcare benefits provide critical services to vulnerable patient populations across the country,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “This settlement reflects our commitment to ensuring that these benefits are used to care for those who need them and not just to enrich those who seek to provide them.”
“Home health is designed to increase health care access for our most vulnerable populations with mobility limitations, while hospice care aims to provide comfort and relief for the terminally ill. Exploiting these systems for financial gain is intolerable,” said Special Agent in Charge Tamala E. Miles of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working with our law enforcement partners, we will continue to pursue health care providers who jeopardize the integrity of these services by prioritizing profit over medically necessary palliative care.”
Starting A Qui Tam Action
Any False Claims Act whistleblower case begins by a relator filing a complaint under seal in the federal court usually for the United States District Court for the district where defendant is located or does business. At the same time, the relator submits a disclosure to the DOJ outlining the material evidence the relator has of the alleged false claims. 31 U.S.C. § 3730(b). The seal period of the complaint lasts 60 days during which the DOJ investigates the claims. 31 U.S.C. § 3730(b)(2). (If necessary, the government can, and often does, extend the 60-day period during which the allegations are kept under seal.) If the government decides to intervene in the case, the government essentially takes over the litigation. 31 U.S.C. § 3730(c)(1). If the government declines to intervene, the relator may proceed with the litigation on his or her own. 31 U.S.C. § 3730(c)(3).
Contact Us
If you have credible information of government fraud in 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=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. In addition to FCA and CFCA whistleblower cases, Ingrid and Evans Law Firm, Inc. also handle 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.
