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Whistleblower Testifies on the Toll Medicaid Fraud Can Take On Patients

At a House Oversight and Government Affairs Committee subcommittee hearing earlier this month, whistleblower Richard West testified about how Medicaid fraud affected the quality of care he received. West, who has muscular dystrophy and qualifies for 16 hours of in-home nursing care every day, said he didn’t receive over 700 hours of in-home nursing care for which Maxim Healthcare Services Inc. billed Medicaid more than $20,000. West told the Congressional committee that he thought it was wrong for someone to profit from his disability while stealing from the government.

In 2004, a New Jersey government agency told West that because he had gone above his monthly benefit cap, his Medicaid services had to be suspended or reduced. He complained first to the state and then to Medicaid and later to a social worker but he says that none of them did anything. He then found a lawyer and filed a whistleblower lawsuit. West says that after he took action, he began having problems with getting home health care nurses to come to him even when he fell ill.

A few months ago, Maxim agreed to settle the Whistleblower lawsuit alleging Medicaid fraud for $130 million. This resolves civil allegations both filed by 43 US states and under the US False Claims Act. The in-home nursing care company will also pay a $20 million criminal fine. As part of its deferred prosecution deal, Maxim took responsibility and admitted conspiring to bilk some $61 million from government health programs. Nine people linked to the Medicaid fraud scam have pleaded guilty to criminal charges and the criminal probe is ongoing.

Because the False Claims Act’s Qui Tam provision entitles whistleblowers to a percentage of what is recovered, West’s portion of the award is $15.4 million.

Maxim Healthcare Agrees to a $150 Million Settlement of U.S. Fraud Probe, Bloomberg, September 12, 2011
Patient Whistleblower Exposes $150 Million Medicaid Fraud, ABC News, December 7, 2011

More Blog Posts:
Whistleblower Lawsuit: Hospice Care Provider Vitas Healthcare Accused of Medicare Fraud, Boston Injury Lawyer Blog, November 27, 2011
Medicare Fraud?: Cigna, UnitedHealth Group, and Aetna Under Scrutiny for Possible Kickback Violations, Boston Injury Lawyer Blog, November 22, 2011
Whistleblower Lawsuit Accuses Florida Hospital of Defrauding Medicare of $2M, Boston Injury Lawyer Blog, November 15, 2011
If you believe you may have reason for filing a Massachusetts whistleblower lawsuit, do not hesitate to contact our Boston injury lawyers at Altman & Altman, LLP to request your free case evaluation.