December 23, 2013
December 23, 2013 — What can health care workers do to stop our nation’s Medicare program from being deluged with fraudulent claims filed by hospitals, doctors and other health care providers? To tackle the problem, the government relies on tips from health care insiders. The False Claims Act incorporates qui tam language that allows conscientious tipsters to bring a lawsuit for the benefit of the government. To incentivize whistleblowers to come forward, the statute entitles tipsters to a share of the recovery.
The Ensign Group Inc., a California provider operating nursing homes in the western U.S., will pay $48 million to settle allegations that the company submitted false claims to Medicare for rehabilitation therapy services that were medically unnecessary. Two whistleblowers who formerly worked for Ensign named six California skilled nursing facilities in a False Claims Act lawsuit:
From 1999 to 2011, these six Ensign nursing homes allegedly filed false claims with Medicare for physical, speech and occupational therapy services provided to patients whose diagnoses did not warrant the services. According to the U.S. Justice Department, Ensign also kept patients in its facilities for time periods exceeding what was medically required to treat patients’ conditions.
Ensign allegedly created a corporate culture in which therapists were improperly paid to boost the amount of therapy given to facility patients as a means of achieving planned Medicare revenue. Medicare targets were established without reference to patient’s actual needs and were impossible to achieve without billing Medicare at the highest reimbursement levels.
The tipsters who notified the government of the alleged abuses were two former Ensign therapists who filed False Claims Act lawsuits under the statute’s qui tam provisions. Carol Sanchez and Gloria Patterson will share in the government’s $48 million settlement, though the specific amounts they will receive have not yet been determined.
Most health care insiders want no part in a Medicare fraud scheme. These honest workers deserve to understand their rights as provided in the False Claims Act before they file suit. With experienced whistleblower lawyers in California — where the False Claims Act violations alleged in this case took place — and in Texas and Maryland, Waters & Kraus understands how to safeguard your interests. When it’s time to notify the government, contact us by email or phone our False Claims Act lawyers at 855.784.0268 to find out more about our Medicare fraud practice.
Our Results
Historic settlement for over 1,300 survivors of clergy and adult abuse within the Roman Catholic Archdiocese of Los Angeles, marking a pivotal moment for justice.
A Philadelphia jury awarded a record verdict against ExxonMobil for failing to warn about cancer risks due to benzene in its petroleum products.
Confidential settlement for the wife of a Rhode Island man who died of mesothelioma cancer after exposure to window glazing compound contaminated with asbestos.
That’s the first question everyone asks. The truth is it’s impossible to know. But we can tell you this. Waters Kraus Paul & Siegel has what it takes to fight against big corporate interests and win. That’s why we’ve recovered more than $1.3 billion for clients like you.
