Whistleblowers Are Urgently Needed to Stop this Type of Massive Fraud
The government has charged three individuals with a conspiracy to collect more than $1 Billion from Medicare and Medicaid for services that patients did not require or were not eligible to receive. The three individuals are the owner of more than 30 nursing homes and assisted living facilities, a hospital administrator, and a physician’s assistant. Yes, you read that correctly. Three individuals are accused of stealing more than $1 Billion from Medicare and Medicaid. According to the FBI, the three individuals were the leaders of a complex conspiracy that included filing false claims with the help of other healthcare providers, and an intricate money laundering scheme designed to hide the flow of payments and kickbacks. The indictment charges that Philip Esformes operated a network of more than 30 nursing homes and assisted living facilities that provided services to thousands of patients. Esformes and his co-conspirators allegedly billed Medicare and Medicaid for medically unnecessary services for many of these patients. The co-conspirators are also charged with receiving kickbacks in return for steering residents to other healthcare providers, who provided additional, medically unnecessary services. The kickbacks allegedly were paid in cash or were disguised as payments for leases, services, or charitable donations to avoid discovery. This case illustrates the critical importance of whistleblowers to uncover billions of dollars in healthcare fraud, waste, and abuse. The government receives millions of claims every day for reimbursement from Medicare, Medicaid, and other government healthcare programs. The claims often set forth nothing more than the patient’s and provider’s identifying information, billing and diagnostic codes, an actual or electronic signature, and a request for payment. Without help from a whistleblower on the inside, it is impossible for the government to determine whether the services were medically necessary, whether they were actually provided to the patients, or whether improper kickbacks were exchanged in return for patient referrals. If you have evidence of Medicare or Medicaid fraud, it is your patriotic duty to come forward and stop the fraud. In return, you are entitled to legal protections and a reward of up to 30% of the amount recovered by the government. In Medicare and Medicaid fraud cases, it is not unusual for those rewards to reach millions of dollars. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley Esq. at (212) 601-2728. Do not delay. There are strict time limits and procedural requirements in order to qualify for a whistleblower reward.
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Regent Management Services will pay $3.2 million to settle allegations that it received kickbacks from ambulance companies in the form of low-cost ambulance transports in exchange for referrals of Regent’s Medicare and Medicaid patients to the ambulance companies.
This is believed to be the first time a nursing home operator, as opposed to an ambulance company, has been held accountable for a “swapping” arrangement. Under such an arrangement, the ambulance company agrees to provide a nursing home or hospital with low-cost ambulance transports when the nursing home or hospital is required to pay for the transports. In return, the nursing home or hospital agrees to refer other patients to the ambulance company when Medicare or Medicaid will pay for the transports. Such “swapping” agreements violate the Anti-Kickback Statute. That law prohibits offering, paying, soliciting, or receiving anything of value in exchange for referrals of items or services covered by Medicare or Medicaid. The federal government has made clear that swapping arrangements are an area of concern throughout the ambulance industry, and that it intends to investigate and prosecute these cases aggressively. If you have evidence that an ambulance company is providing low-cost services to a hospital or nursing home in exchange for referrals of Medicare or Medicaid patients back to the ambulance company, then you should consult with an experienced whistleblower lawyer immediately. You may be eligible for a substantial financial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. Lawsuits Claim Skilled Nursing Chain Submitted False Claims to Medicare for Medically Unnecessary Rehabilitation Therapy
Three whistleblowers have received the backing of the federal government in their False Claims Act lawsuits against SavaSeniorCare LLC. The company operates approximately 200 skilled nursing facilities. According to the whistleblowers, the company submitted false claims to Medicare for rehabilitation therapy services that were not medically necessary. They claim that the company set targets for Medicare reimbursement rates without regard to patient needs, and then pressured staff to meet those targets. As a result of this pressure, the whistleblowers claim, patients continued to remain in the facilities even after they were medically ready to be discharged. The whistleblowers brought their claims under the qui tam provisions of the False Claims Act. That law allows individual citizens to file lawsuits on behalf of the government and to share in any recovery. The lawsuits were filed “under seal” (in secret) and the whistleblowers' evidence was provided to the government. After conducting an investigation, the government decided to intervene in the lawsuits. The whistleblowers will be entitled to a reward of between 15% and 25% of the amount to government recovers as a result of their qui tam lawsuits. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial financial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. A former Abbott Laboratories employee will receive a $1 million whistleblower reward for reporting kickbacks between the pharmaceutical giant and the second largest nursing home consulting pharmacy in the country.
Meredith McCoyd and another former Abbott Laboratories employee brought lawsuits under the qui tam or whistleblower provisions of the False Claims Act. Under that law, an individual citizen who has evidence of false claims submitted to government programs may start a lawsuit on behalf of the government. The lawsuit is filed “under seal” (in secret) and the evidence is disclosed only to the government. The government then investigates the claims and decides whether to pursue the suit. If the government recovers money as a result of the lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount actually recovered. Ms. McCoyd filed a qui tam lawsuit alleging that Abbott Laboratories paid kickbacks to pharmacies in exchange for promoting the company’s prescription drug Depakote for nursing home patients. She alleged that the kickbacks were disguised as rebates, educational grants and other financial support. Under the Anti-Kickback Law, it is illegal for a pharmaceutical company or healthcare provider to offer or pay anything of value in return for referrals of Medicare or Medicaid patients. If kickbacks are paid, then every resulting claim for reimbursement is deemed a “false claim.” Both the entity that pays the kickbacks and the entity that receives the kickbacks may be liable for treble damages and penalties. In this case, the consulting pharmacy agreed to pay $6.5 million to the federal government and $2.5 million to state governments to resolve claims that it accepted kickbacks from Abbott Laboratories. The whistleblower who started the qui tam lawsuit will receive a reward of $1 million from the federal government. She may also receive whistleblower rewards from the state governments under their false claims acts. If you have evidence that a pharmaceutical company or healthcare provider is paying or receiving anything of value in return for patient referrals, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be eligible for a substantial reward and legal protections as a whistleblower. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. |