A $25 million settlement has been reached in the whistleblower lawsuit filed by a former nurse employee against Odyssey HealthCare Inc. Per her Qui Tam complaint, submitted in 2008, between 2006 and 2009 Odyssey enrolled and recertified patients who were non-terminal for hospice care, and billed for services that weren’t reasonable or necessary.
Medicare’s benefit, which covers hospice care, is only for patients that are terminally ill. To be eligible for palliative hospice care, a patient must be diagnosed as having six months of less to live.
The plaintiff who filed the whistleblower lawsuit alleging Medicare fraud, Jane Tuchalski, was fired by Odyssey after she expressed concerns about how the hospice care company was run. (She has since settled a separate settlement related to retaliatory termination claim.) Other Odyssey employees also filed their own whistleblower complaints alleging hospice care fraud. While one of the cases was added to Tuchalski’s lawsuit, the other was later dismissed.
Odyssey is now part of Gentiva Health Service, which noted that the allegations of hospice care fraud were for a period of time that occurred prior to its acquisition of the company. Gentiva said that settling the whistleblower case is a reflection of its commitment to making sure compliance is company-wide.
Because Tuchalski filed her whistleblower lawsuit under the False Claims Act, she is entitled to a percentage of what the government recovers. Also, under the act, employees who are fired for disclosing fraud are eligible to recover double back pay, special damages, and benefits.
In cases when multiple claims are submitted by different employees or others, it is usually the first person to file whistleblower lawsuit that receives the most from the financial recovery. In the hospice fraud case against Odyssey, claimants will get about $4.6 million.
Whistle-blower case on hospice fraud settled for $25 million, JSOnline, March 1, 2012
Hospice Provider Odyssey Healthcare Agrees to Pay $25 Million to Resolve False Claims Act Allegations, Justice.gov, March 1, 2012
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