Grace Healthcare LLC will pay $2.7M with interest to resolve fraud violations that it either knew of or caused their submission related to the Medicare and TennCare/Medicaid programs. The allegations were reported in a whistleblower lawsuit filed by one of the nursing home manager’s former employees, who will now receive $405,000 per the Qui Tam provisions of the act, which not only lets private citizens sue for Medicare and Medicaid fraud on the US government’s behalf but also allows them to receive a percentage of any recovery.
By settling, Grace Healthcare is not denying or admitting to the allegations. The US Justice Department, however, says that the nursing home company turned in false claims for rehabilitation services that were not medically necessary or reasonable, including occupational, physical, and speech therapy services that were provided at 10 facilities to fulfill their Medicare revenue goals, which were purportedly determined without factoring the patients’ actual individual needs for therapy.
Meantime, Legal News Online is reporting that since January 2009, the US Department of Justice has recovered over $14 billion in false claims cases, including $10.2 billion related to fraud committed against federal health care programs.
Qui Tam Actions
If you believe that a fraud is being perpetuated against the government, you may want to file a whistleblower lawsuit on its behalf. Not only could you expose and help stop a serious crime but also, you may be entitled to a percentage of any recovery.
The False Claims Act allows whistleblowers to file a Qui Tam action over any fraud involving a state or federally funded program or contract except for tax fraud.
In Massachusetts, you want to work with a Boston whistleblower law firm that can represent you and your case from beginning to end and will know what steps you need to take to achieve the most successful outcome possible.
Nursing home to pay $2.7M for False Claims Act violations, Legal Newsline, March 25, 2013
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Whistleblower Lawsuit Accuses Dialysis Company DaVita Inc. of Overbilling Medicare and Medicaid by Hundreds of Millions of Dollars, Boston Injury Lawyer Blog, December 22, 2013
$25M Whistleblower Settlement Reached in Hospice Fraud Case Against Odyssey Healthcare Inc., Boston Injury Lawyer Blog, March 25, 2012
Pfizer Settles Whistleblower Claim Alleging Pharmaceutical Fraud Related to Detrol, Boston Injury Lawyer Blog, October 19, 2011