A former nursing home employee will receive a $405,000 whistleblower reward for helping the government uncover false claims submitted to Medicare and Medicaid for physical, occupational, and speech therapy services.

Doug Ottinger, a former administrative assistant at Grace Healthcare, went to the government with evidence that his former employer had billed Medicare and Medicaid for physical, occupational, and speech therapy services that were not medically necessary.

The government investigated the allegations and decided to join in a lawsuit against the nursing home management company.  The lawsuit alleged that Grace pressured therapists to increase the amount of therapy provided to patients in order to meet targets for Medicare revenue.  Those revenue targets, the government alleged, were established without regard to an individual patient’s need for therapy.

The company agreed to settle the case by paying $2.7 million.  Mr. Ottinger will receive $405,000 of that amount as his whistleblower reward.

The lawsuit was filed under the qui tam or whistleblower provisions of the federal False Claims Act.  The qui tam provisions allow an individual citizen to bring a whistleblower lawsuit on behalf of the government and share in any recovery. 

In this case, the former employee’s lawsuit was filed “under seal” (in secret) and disclosed only to the government.  After investigating his allegations, the government decided to intervene or join in the lawsuit.  The government then took the lead in the lawsuit against his former employer and negotiated the settlement.

If you are aware that your current or former employer has submitted claims to Medicare or Medicaid for products or services that were not necessary or not actually provided, then you should consult with an experienced Medicare whistleblower attorney immediately.  You may be entitled to a substantial whistleblower reward and legal protections.

To arrange for a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our offices via email.

John Howley, Esq.

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