In The News

Prosecutor Not Allowed to Intervene in Lawsuit against Sprint

Joining a suit as a whistleblower is not always cut and dry. This was proven to be the case when earlier this month, The Ninth Circuit court in San Francisco ruled that a prosecutor, who had accused Sprint of cheating the United States out of millions of dollars in surveillance services, would not be able to intervene in the government’s lawsuit against the telecom. A three-judge appeals panel ruled that the prosecutor, John Christopher Prather, did not have a “significantly protectable interest” in the government’s False Claim Act suit against Sprint. The court also ruled that Prather was not entitled to a share of the settlement simply because he had filed a qui tam lawsuit in 2009. U.S. Circuit Judge Marsha Berzon wrote for the court in a 20-page opinion that Prather could not, “…obtain a monetary bounty under the FCA on his jurisdictionally barred claims…by joining a related FCA action brought by the government after the dismissal of his qui tam action.”

Prather maintains that while working for the New York Attorney General’s Organized Crime Taskforce and the Metropolitan Transportation Authority of the Inspector General in the 2000s he noticed the cost of government wiretapping rising greatly. Prather stated that the labor cost of bugging cell phones should have been less expensive than bugging landline phones. Prather maintained that the FBI and the Justice Department was charged 10 times what they should have been. Prather says he grew suspicious of these rising costs and decided to file a whistleblower suit in 2009 under the FCA against Sprint, AT&T, Verizon and two other phone companies. The government did not intervene in the case at the time. U.S. District Judge Charles Breyer dismissed the suit in 2013 because Prather wasn’t the original source of the fraud allegations. Sprint eventually agreed to pay $15 million to settle the case.

The Ninth Circuit ruling was based on in part by The Supreme Court’s 2007 decision in Rockwell International Corp. v. United States. The court ruled in that case that government intervention could not supersede a plaintiff’s failure to qualify as the originator of the FCA suit. If you have chosen to disclose wrongdoing it is also advised that you contact a qui tam law firm. Attorneys who work for qui tam law firms can advise you on such matters and will work to protect your rights under the law.


Two Missouri Hospitals Agree to Pay $34 Million to Settle Alleged False Claims Act Violations

Part of the government’s effort at cracking down on health care fraud involves ensuring that healthcare providers remain motivated by medical necessity when it comes to treating patients and not by profit. This idea was demonstrated this week when The Department of Justice announced that Two Southwest Missouri health care providers had agreed to pay $34 million to resolve allegations that they violated the False Claims Act by engaging in improper financial relationships with referring physicians. The defendants are Mercy Hospital Springfield f/k/a St. John’s Regional Health Center and its affiliate, Mercy Clinic Springfield Communities. The defendants operate a hospital, clinic and infusion center.

The settlement resolves allegations that the health care providers submitted false claims to the Medicare Program for chemotherapy services rendered to patients referred by oncologists. The formula used in referring patients to these oncologists improperly took into account the value of their referrals to the infusion center operated by the institutions. Federal law limits the financial relationship that hospitals may have with doctors who refer patients to them. “When physicians are rewarded financially for referring patients to hospitals or other health care providers, it can affect their medical judgment, resulting in overutilization of services that drives up health care costs for everyone,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable.”

The allegations arose from a lawsuit filed by a whistleblower, Dr. Viran Roger Holden, a physician who was employed by one of the defendants. Dr. Holden’s lawsuit was filed based on the qui tam provisions of the False Claims Act. Under these provisions, private citizens can sue on behalf of the government for false claims and share in any subsequent recovery. Dr. Holden is scheduled to receive $5,440,000 as his share of the settlement. “When physician compensation improperly accounts for referrals, patients are left to wonder whether their doctor’s judgment has been tainted and motivated by financial interests,” said Special Agent in Charge Steven Hanson for the Department of Health and Human Services Office of the Inspector General. “Illegal financial reward has no place in health care. Today’s settlement should send a message that, together with our law enforcement partners, we will pursue these cases.”

The government’s intervention in this complaint illustrates its emphasis on combating health care fraud which goes back to the previous administration. The False Claims Act is one powerful tool it uses to prosecute offenders. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477). If you have chosen to disclose wrongdoing it is also advised that you contact a whistleblower law firm. Whistleblower Medicare attorneys can advise you on such matters and will work to protect your rights under the law.


Indiana University Health and HealthNet Agree to $18 Million Settlement to Resolve Alleged False Claims Act Violations

Alleged violations of the Anti-Kickback Statute is a common theme among companies that are accused of governmental fraud. This fact was born out last month when Indiana University Health Inc. (IU Health) and Health Net, Inc. agreed to pay $18 million to resolve allegations that they violated state and federal false claims laws by engaging in an illegal kickback scheme related to the referral of IU Health’s OB/GYN patients to IU Health’s Methodist Hospital. Under the settlement agreement, IU Health and Health Net, Inc. agreed to pay $5.1 million to the United States and $3.9 million to the State of Indiana. “The payment of illegal remuneration to induce patient referrals interferes with health care providers’ independent judgment when they make referral decisions for their patients,” said Deputy Assistant Attorney General Joyce R. Branda for the Civil Division. “We will continue to pursue health care providers that engage in such conduct, which undermines public confidence in our health care system.”

 

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b.) prohibits the knowing and willful payment of any remuneration to induce the referral of services or items that are paid by a federal health care program such as Medicaid, Medicare, TRICARE etc. Claims that violate the Anti-Kickback Statue are also false claims under the False Claims Act. The government alleged that from May 2013 through August 2016, IU Health provided HealthNet with an interest-free line of credit exceeding $10 million. The US further alleged that HealthNet was not expected to repay a large portion of this loan based on a financial arrangement between the two meant to induce HealthNet to refer its patients to IU Health’s Methodist Hospital.

 

“Helping to return millions of dollars in taxpayer funds to federal healthcare programs and the Indiana Medicaid program is critically important to me and my office,” said U.S. Attorney Joshua Minkler for the Southern District of Indiana. “Waste, fraud, and abuse can never be tolerated and tear at the fabric of first-class healthcare in this country.” The settlement came about as the result of a lawsuit that was filed by Dr. Judith Robinson, who formerly held a number of positions at both Methodist Hospital and HealthNet. Dr. Robinson filed her lawsuit in federal court in Indianapolis under the qui tam provisions of the False Claims Act. The qui tam provisions permit private individuals to bring a lawsuit on behalf of the government and to share in any subsequent recovery. Dr. Robinson is scheduled to receive approximately $2.8 million out of the federal share of the recovery. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477). If you have chosen to disclose wrongdoing it is also advised that you contact a qui tam attorney. A qui tam lawyer can advise you on such matters and will work to protect your rights under the law.


The Virginia Department of Social Services Agrees to Pay $7.1 Million to Resolve Allegations that it Violated the False Claims Act

Sometimes alleged fraudulent activities committed against the government are nurtured by an entire administrative culture. This was the case when last month the Justice Department announced that the Virginia Department of Social Services (VDSS) had agreed to pay the government $7,150,436 to settle allegations that it violated the False Claims Act in regards to the Supplemental Nutrition Assistance Program (SNAP). SNAP is a program administered by the U.S. Department of Agriculture (USDA) that provides financial assistance for low-income families and individuals to buy nutritious food. Since 2010, SNAP has served more than 45 million Americans per month. “SNAP is an important vehicle for helping needy families,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “This settlement reflects the Justice Department’s commitment to ensuring that taxpayer funds are spent appropriately so that the public can have confidence in the integrity of vital programs like SNAP.”

 

The government relies on the states to determine the eligibility of applicants, to administer benefits for the same and to perform quality control to ensure that the eligibility decisions are correct. The USDA reimburses states for their administrative expenses in administering SNAP. The government also pays performance bonuses to states that report the lowest and most improved error rates each year. Finally, it can also impose monetary sanctions for states that do not improve. VDSS admitted, as part of the settlement, that beginning in 2010 it retained a quality control consultant to reduce its SNAP benefits determination error rate by training QC workers to “use whatever means necessary” to find a benefits decision “correct” rather than in error. Moreover, VDSS admitted that when control staff could not find a benefits decision to be correct, that they were instructed to find a reason to drop the case. Through its use of these biased methods, VDSS was improperly awarded USDA bonuses from 2011 – 2013.

 

VDSS further admitted that QC workers did not want to use the methods proposed by the consultant VDSS retained. VDSS said that the QC workers did not wish to do so because they believed the method lacked integrity, injected bias into the QC process and that it violated USDA regulations. QC workers communicated these concerns to their manager but were pressured by being threatened with termination and negative performance reviews. VDSS also admitted that workers who complained about the process were denied teleworking and flexible scheduling privileges and otherwise harassed. As part of the settlement agreement, VDSS has taken corrective actions that began back in 2015. Namely, it agreed to terminate its use of the improper quality controls methods devised by Julie Osnes Consulting.

 

“We appreciate the commitment and investigative assistance provided by our partners at the U.S. Department of Justice’s Civil Division, U.S. Attorney’s Office, and Virginia Office of the State Inspector General,” said Special Agent-in-Charge Bethanne M. Dinkins of the USDA Office of Inspector General (OIG). “We also wish to note the technical assistance provided by our colleagues in the Office of Audit at USDA, OIG. During our investigation, we worked together to address the concerns of state employees and others who alleged that the integrity of the SNAP quality control process was weakened by third-party consultants.” Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477). If you have chosen to disclose wrongdoing it is also advised that you contact a false claim act attorney. Whistleblower lawyers specialize in all areas related to the False Claims Act and will be able to advise you on such matters.


Quest Diagnostic Agrees to Pay $6 Million to Settle Allegations of Kickbacks and Unnecessary Testing

The government’s prosecution on companies that put monetary gain over medical consideration is a common theme in its crackdown against health care fraud. The government proved this fact last week when the Justice Department announced that a blood laboratory testing company Quest Diagnostics had agreed to pay $6 million to resolve allegations that it violated the False Claims Act by paying kickbacks to physicians and patients to induce the use of their Berkeley HeartLab facility in Alameda, California. Quest has also been accused of having charged for medically unnecessary tests as well. Quest acquired Berkeley HeartLab Inc., (BHI) in 2011 and has ended the conduct that prompted the settlement. “We rely on doctors to provide honest, independent recommendations regarding clinical testing,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “Companies that pay kickbacks to referring doctors corrupt those doctors’ independence, leaving patients vulnerable to expensive and unnecessary testing.”

 

According to the government’s complaint, BHI paid kickbacks in the form of “process and handling fees” to physicians. The complaint also alleged that BHI waived copayments owed by certain patients who were legally required to pay for part of their tests. These alleged kickbacks were meant to induce patients and doctors as an incentive for them to choose BHI over other laboratories. Moreover, the complaint alleged that these practices resulted in medically unnecessary cardiovascular tests being charged to federal health care programs. The Anti-Kickback Statute (42 U.S. Code § 1320a–7b) prohibits offering, paying, soliciting or receiving remuneration to induce services covered by federally funded programs. The statute is intended to ensure that a physician’s medical judgment is not influenced by improper financial incentives. The statute also prohibits routinely waiving patient copayments to ensure that patients are incentivized to reject medically unnecessary tests.

 

“The South Carolina U.S. Attorney’s Office has dedicated considerable resources to pursuing fraud cases that divert federal taxpayer dollars from important programs, like health care and defense contracting,” said U.S. Attorney Beth Drake of the District of South Carolina. “The goal for our qui tam unit is to protect taxpayers, patients, and soldiers by ensuring that important decisions are made according to medical science and engineering, and not based on dollar signs.”

 

The original lawsuit was filed by Dr. Michael Mayes under the qui tam, or whistleblower, provisions of the False Claims Act. Under this act, private citizens can sue on behalf of the federal government for False Claim Act violations and share in any recovery. The United States partially intervened in this and two other actions on March 31, 2015. The remaining defendants are Latonya Mallory, the former CEO of Health Diagnostics Laboratory, Inc., and marketing company BlueWave Healthcare Consultants, Inc. and its owners, Floyd Calhoun Dent III and Robert Bradford Johnson. Dr. Mayes’ share of the settlement has not yet been determined. In 2015 the government announced settlements with two other laboratories – Health Diagnostics Laboratory Inc. of Richmond, Virginia and Singulex, Inc., of Alameda, California – for engaging in similar conduct. The settlement and the government’s intervention in the lawsuit brought forward by Dr. Mayes illustrate its ongoing efforts to combat health care fraud which began back in the Obama administration.

 

Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477). If you have chosen to disclose wrongdoing it is also advised that you contact a qui tam attorney. Qui tam attorneys can advise you on such matters and will work to protect your rights under the law.


Pacific Pulmonary Services Pays $11.4 Million to Resolve False Claims Act Allegations

The prosecution of False Claims Act violations continues under the new administration as the Department of Justice announced late last month that Braden Partners, L.P., dba Pacific Pulmonary Services (PPS), would be paying $11.4 million to resolve False Claim Act violations for submitting claims to Medicare and other healthcare programs for oxygen equipment supplied in violation of program rules. PPS – along with its general partner Teijin Pharma USA LLC – is also alleged to have supplied sleep therapy equipment as part of a cross-referral kickback scheme with sleep clinics. “This settlement demonstrates our continued pursuit of health care providers who take advantage of federal healthcare programs,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “We will investigate and take action against providers who cut corners and pay kickbacks.”

 

PPS – which is based in California – furnishes stationary and portable oxygen tanks and related supplies as well as sleep equipment to patients’ homes in California and other states. The government alleged that beginning in 2004, PPS began submitting claims to Medicare, TRICARE and Federal Employee Health Benefits programs for home oxygen and oxygen equipment without first obtaining physician authorization. This approval is required per program rules. Beginning in 2006, some of the company’s patient care coordinators allegedly agreed to make patient referrals to sleep testing clinics in exchange for those clinics’ agreement to refer patients to PPS for sleep therapy equipment. The government alleged that this violated the Anti-Kickback Act ((42 U.S. Code § 1320a–7b). This act prohibits offering, paying, soliciting or receiving remuneration to include referrals of items or services covered by Medicare, Medicaid and/or other federally funded programs.

 

“The U.S. Attorney’s Office is committed to taking all appropriate action against companies that disregard patients’ medical needs in pursuit of company profits,” said U.S. Attorney Brian J. Stretch for the Northern District of California. “Patients in federal health care programs expect and deserve medical care that is free from any undue influence and complies with the program safeguards that are in place to protect patients.” The $11.4 million settlement resolves allegations that were filed in a lawsuit by a former sales representative (Manuel Alcaine) of PPS. The case was filed in federal court in San Francisco, California. Mr. Alcaine filed his suit under the qui tam, or whistleblower, provisions of the False Claims Act which permits individuals to sue institutions on behalf of the federal government for false claims and to share in any subsequent recovery. Mr. Alcaine will receive $1.824 million of the recovered funds.

 

Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477). If you have chosen to disclose wrongdoing it is also advised that you contact a qui tam law firm. Qui tam law firms specialize in all areas related to the False Claims Act and will be able to advise you on such matters.


California Whistleblower is joined by the Government in a Lawsuit Against UnitedHealth Group

The Department of Justice announced earlier this month that the government has joined a lawsuit that has been filed against UnitedHealth Group (UHG) by a whistleblower. The government formally filed papers to intervene in the suit in late March of this year. The suit was originally filed by whistleblower James Swoben in 2009. Swoben has accused the company of taking advantage of the Medicare Advantage payment system by misrepresenting the health status of its patients. This was done by UHG, Swoben alleges, in an effort to boost payment rates from the federal Medicare program. Furthermore, Swoben has alleged that he has proof that UHG has been involved in fraudulent activities that could have cost the government more than $1 billion.

 

For its part UHG denies any wrongdoing. “We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality healthcare we provided, and confident we complied with program rules,” said UnitedHealth spokesman Matt Burns. On the other hand, the case in which the government has intervened involves government payments that Swoben and the Justice Department maintain, “gamed” the rules for “risk adjustment.” Under these rules, government payments are adjusted upward for insurers who cover patients with costlier health conditions. The government alleges that UHG boosted adjustment claims by submitting forms for conditions that health plan members did not have.

 

Medicare Advantage – which serves as an alternative to Medicare – is used by more than 18 million disabled and elderly Americans and cost nearly $150 billion a year to maintain. In the past, nearly half a dozen whistleblower Medicare lawsuits have been filed against companies that are alleged to have over-billed or otherwise committed fraud against the popular program. “This is not one company engaged in episodic bad behavior, but a lucrative business plan that appears to be national in scope,” said Patrick Burns associate director of Taxpayers Against Fraud in Washington. The group is a nonprofit profit organization supported by whistleblowers and their lawyers.

 

The government is also attempting to combine the Swoben case with another whistleblower action filed in 2011 by former UnitedHealth executive Benjamin Poehling. Poehling alleged then that UHG generated hundreds of millions in overpayments. If you have chosen to disclose False Claims Act violations to the government it is also advised that you contact a whistleblower law firm. A whistleblower attorney can advise you in such matters and will work to protect your rights under the law.


Judge Allows MedStar Health False Claims Act Case to Go Forward

Judge Allows MedStar Health False Claims Act Case to Go Forward

 

Often, some of the firms involved in allegations of False Claims Act violations come up more than once in this blog. This is the case with MedStar Health. Last month an Illinois Judge – Judge Robert Dow Jr. of U.S. District Court Judge in Illinois – ruled that a False Claim Act violation case could proceed against MedStar and Accretive. The suit was first filed by MedStar Washington Hospital Center employee Cherry Gaziosi who alleged that she helped submit false claims to Medicare, Tricare and Medicaid on behalf of Accretive Health Inc. Accretive Health is based in Chicago and is one of the largest hospital revenue cycle management companies in the United States. In January of this year, Accretive Health changed its name to R1 RCM Inc. Tricare is a health care program for uniformed service members and their families.

 

Specifically, Gaziosi alleged that MedStar conspired with Accretive in order to change patient treatments solely to increase patient admissions. Moreover, Gaziosi maintains that these changes were made without regard to medical necessity. As a result of this action, Medicare is believed to have paid more for inpatient admissions than it did for observational stays. “Accretive for a number of years peddled a practice to top hospital administrators at a significant number of hospitals around the country, convincing them that Accretive could provide to the hospitals what they called a ‘revenue lift’ particularly from the Medicare system,” Brad Pigott of Pigott & Johnson PA in Jackson, Miss. Pigott represents Ms. Gaziosi and is a False Claims Act attorney. The qui tam provisions of The False Claims Act allow whistleblowers to sue on behalf of the government and to receive a portion of any damages recovered.

 

Gaziosi further alleged that Accretive created documentation, which sought to justify inpatient admissions for patients who were otherwise determined not to have met a medical necessity. Emergency department staff previously made this determination. In 2015, MedStar Health was among 500 hospitals that paid a $250 million dollar settlement to the U.S. Department of Justice for irregularities concerning the implantation of cardiac devices in Medicare patients. Drinker Biddle & Reath LLP in Washington represents MedStar. Kirkland & Ellis LLP in Washington represents Accretive.

 

If you know of abuse that has been committed against the government or one of its agencies, you are encouraged to report it and to contact a whistleblower lawyer. Whistleblower lawyers will be able to advise you in such matters and will work to protect your rights.


CEO of Barclays Comes Under Investigation for Trying to Identify a Whistleblower

Although this blog is filled with instances of whistleblowers being awarded huge settlements, there is still a great deal of risk involved in engaging in this protected activity. This was demonstrated last week when financial regulators from the Financial Conduct Authority (FCA) and the Prudential Regulation Authority (PRA) announced that they were investigating Barclays’ Chief Executive Officer (CEO) Jes Staley’s alleged attempts to unmask a whistle-blower at the company. Barclays – a British multinational banking and financial services company headquartered in London – is one of Britain’s top banks. Staley has been accused of attempting to identify the author of a letter written earlier this year by an employee/whistleblower. As a result of these accusations, Barclays’ board engaged the independent law firm Simmons & Simmons, LLP to lead the investigation into Staley’s alleged misconduct. “I am personally very disappointed and apologetic that this situation has occurred, particularly as we strive to operate to the highest possible ethical standards,” Barclays’ chairman John McFarlane said in a statement.

In the past, Barclays has been embroiled in a number of controversies including alleged regulatory misdemeanors. Specifically, its former CEO resigned from the group during a high profile investigation into Libor (London Interbank Offered Rate) rigging. The Libor Scandal involved a series of transactions connected to the bank. The Libor is an interest rate reached by averaging the interest rates at a number of major banks around the world. The outcome of that case was that the bank was fined nearly £290m ($374.68 million USD.) This latest controversy involving Staley began back in June 2016. Two anonymous letters were sent from the US to some of Barclays board members. The letters concerned Tim Main a friend of Staley and a colleague of his when the two worked at JP Morgan.

According to the FCA/PRA investigation, Staley made two attempts to discover the identity of the whistleblower even attempting at one point to utilize the help of a US law enforcement agency. Though Staley has defended his actions by saying that he honestly believed he was entitled to the information, corporate rules regarding whistleblowing are clear. They stipulate that if an informer asks for anonymity a firm must respect the request. However, Staley is said to have violated this rule because he felt that the content of the letters constituted an “unfair attack” on Main. As a result of this, it is speculated that Staley then asked the bank’s information security team to discover the identity of the author on more than one occasion.

Ironically, Staley stated that he would work to strengthen trust in the bank in light of the aforementioned Libor Scandal. In a statement from the bank’s Board, a spokesman defended Staley’s action. “The investigation… found, and the Board has concluded, that Mr. Staley honestly, but mistakenly, believed that it was permissible to identify the author of the letter.” Staley has received a written reprimand and a pay cut from the board as punishment. If you have chosen to disclose wrongdoing it is also advised that you contact a qui tam lawyer. A qui tam attorney can advise you in such matters and will work to protect your rights under the law.


Jury Awards $115 Million to Whistleblower in False Claims Case Against Florida Nursing Home Facility

Occasionally, whistle-blowers win in cases where the government has not intervened. Such was the case early last month when a federal jury in Florida awarded a nurse, Angela Ruckh, $115 million to settle her False Claims Act suit against her employer (LaVie Management and later CMC II). Ms. Ruckh had alleged that the company had engaged in a fraudulent scheme against the government that was “encouraged by senior officers.” Moreover, Ruckh stated that the scheme actively encouraged employees to falsify claims submitted to the government. The original False Claims Act lawsuit was filed back in 2011. Ruckh began working for Lavie Rehab, a skilled nursing facility, back in February of that same year. After working for a short time, Ruckh discovered what she believed were fraudulent activities being committed by senior officers at the facility.

Ruckh discovered these fraudulent activities through her work which involved helping to train minimum data set (MDS) coordinators. (MDS forms generate a code that determines how much Medicare pays each facility.) Ruckh alleged that there was a treatment disparity between Medicare and Medicaid patients. The former nurse claimed that LaVie treated patients who were on Medicaid as if they did not have a payer source. This lead to different treatment for patients with the same condition based solely on which program they were covered under. Specifically, Ruckh alleged that Medicare claims were based on upcoding.

Ruchk also alleged that Lavie Rehab “ramped up” therapy for patients based on monetary considerations. “They would take 88 to 92 year old people with multiple major health problems — heart problems, dementia, kidney failure, some of whom were on hospice care at the end of life — and they were giving them the highest amount of therapy under the Medicare guidelines. People who could only sit up straight for two minutes without passing out were subjecting them to 720 minutes, 12 hours of therapy a week,” Ruchk said. A statistician was used to help bolster Ruchk’s claims. He used a random sample of Medicaid and Medicare patients and reviewed Ruchk’s claims of upcoding and “amping.” Another nurse and auditor, Shirley Bradley, concluded that on the basis of these findings Medicaid patients were generally ignored and received no or inferior care. “They [LaVie Rehab] didn’t create care plans for the Medicaid patients because that would have been a road map to show that they weren’t providing the care needed. It made no sense to them to produce a plan that would show the care that they were not providing. It would have been a road map showing the disregard for the patient,” said Bradley.

Ruchk’s award of $115 million was determined by the number of submitted false claims. Each false claim is subject to a monetary penalty of between $5,500 and $11,000. If you have chosen to disclose False Claims Act violations to the government it is also advised that you contact a False Claims Act lawyer. A False claims act attorney can advise you in such matters and will work to protect your rights under the law.