December 15, 2014 — The False Claims Act empowers health care insiders to file a whistleblower lawsuit on the government’s behalf. Courageous whistleblowers help to protect the integrity of our federal healthcare programs, like Medicare or Medicaid, by notifying the government when unscrupulous health care providers engage in upcoding and other billing violations. Upcoding is the practice of seeking reimbursement from an insurer or federal healthcare program for more expensive levels of medical care than were actually provided. Some unethical health care providers encourage doctors to bill for services at the highest levels, without reference to the actual level of service provided. The qui tam provisions of the federal False Claims Act reward tipsters for coming forward by making informants eligible for a portion of the government’s recovery as a result of the lawsuit.
False Claims Act Lawsuit Alleged Upcoding Violations By Tennessee Home Health Care Provider
CareAll Management LLC and its related companies (“CareAll”) will pay $25 million to settle a False Claims Act lawsuit alleging that CareAll filed false claims with Medicare and the Tennessee Medicaid program. The whistleblower in the lawsuit was Toney Gonzales, whose share of the settlement will be more than $3.9 million. Gonzales alleged that CareAll submitted requests for reimbursement that included upcoding violations and other false claims.
CareAll, a Tennessee corporation, is one of the largest home healthcare providers in that state. From 2006 to 2013, CareAll reportedly exaggerated the seriousness of its patients’ illnesses so that it could bill the government healthcare programs for medical services that were unnecessary and that were provided to patients whose conditions did not confine them to their homes.
CareAll is not unfamiliar with alleged False Claims Act violations. The home health care provider was required to spend more than $9 million in 2012 to settle allegations that it had filed false cost reports with Medicare. To ensure the CareAll entities’ future compliance with Medicare and Medicaid requirements, CareAll has consented to be bound by a corporate integrity agreement with the Department of Health and Human Services-Office of Inspector General.
False Claims Act Lawsuits Target Abuse By Medical Providers
While Waters & Kraus is not handling this particular False Claims Act case, we are representing whistleblowers in similar lawsuits. If you have comparable claims against a different medical provider, email us or call our qui tam attorneys at 855.784.0268 to learn more about our practice and how we can work together to notify the government about fraudulent abuses of government-funded programs. Our whistleblower lawyers, such as Paul Lawrence in the firm’s Washington D.C. area office and Gary Paul in the California office, protect tipsters throughout the qui tam lawsuit process.