June 11, 2013 — Courageous whistleblowers help to return millions of taxpayer dollars to the state and federal governments each year by filing claims under the federal False Claims Act. The qui tam language of the Act authorizes health care employees who learn about fraudulent Medicare and Medicaid billing scams to file a lawsuit against unethical health care providers on behalf of the government. Tipsters keep a portion of the government’s financial recovery. While anyone who has unique information about the submission of false claims can file a whistleblower lawsuit, insider informants are the best situated to spot fraud first and notify the government.
False Claims Submitted to Medicare in PHP Fraud Scheme
Wondera Eason, a Miami supervisor of Health Care Solutions Network (HCSN), a mental health care company, has been convicted for conspiring to run a $63 million interstate health care fraud scheme. Wondera Eason worked as the Director of Medical Records for HCSN’s Florida Partial Hospitalization Program (PHP). HCSN originally operated two Florida community mental health centers that offered PHP, which is a type of intensive treatment for patients with severe mental illness. After bilking the government out of millions of dollars, HCSN opened a third operation in North Carolina. The evidence at trial demonstrated that between 2004 and 2011, HCSN submitted around $63 million in false claims to Medicaid and Medicare.
According to the Justice Department, the scam worked like this: HCSN enlisted the help of Assisted Living Facilities (ALF) in the Miami area to refer Medicaid and Medicare patients to HCSN in exchange for illegal kickbacks. Many of those patients were not eligible for PHP services because they were not mentally ill. Instead, they were mentally retarded or had Alzheimer’s disease or dementia. The alleged treatment the patients received at HCSN frequently included playing bingo and watching movies. Meanwhile, HCSN submitted millions of dollars of fraudulent claims to Florida’s Medicaid program and to the federal Medicare program.
Eason was a certified medical records technician who orchestrated the creation of thousands of false documents to support the health care fraud operation. Eason instructed HCSN therapists to create false documents and she forged therapists’ signatures on other documents. She provided Medicaid and Medicare auditors with false documents, all the while certifying that they were accurate. Sometimes, Eason fixed up the phony medical records weeks or even months after the patients received their purported “therapy.”
Eason is just one of fifteen defendants that have been charged in the Medicare and Medicaid fraud scam. Three owners of the assisted living facilities that funneled Medicare beneficiaries to HCSN have already been sentenced to prison.
False Claims Act Lawsuits Often Filed by Health Care Insiders
The more employees pressured to take part in a Medicaid scam that involves falsification of patient records and illegal kickbacks, the more likely it is to be uncovered. Even so, it is not always easy to collaborate with the government when your employer or a coworker is engaged in Medicare fraud. Tipsters who notify the Justice Department about health care fraud deserve to know their own legal rights from the beginning. With law offices across the country, Waters & Kraus offers conscientious informants the experienced legal counsel they need. Contact us by email or call our qui tam lawyers at 855.784.0268 to learn how we can safeguard your interests.