July 25, 2013 — Heath care fraud costs our country massive amounts every year. The Justice Department relies on insiders to obtain the evidence needed to stop fraud. The False Claims Act’s qui tam provisions authorize health care workers who discover overbilling, misreporting, and/or other fraudulent conduct to file suit on behalf of the government. These whistleblowers are then eligible to share in any recovery by the government.
$63 Million Medicare and Medicaid Fraud Scheme Results in 10-Year Prison Term
Following her April 25th conviction for conspiracy to commit health care fraud, Florida resident Wondera Eason, a former supervisor at now-defunct health care provider Health Care Solutions Network Inc. (HCSN), has been sentenced to 10 years in prison. Ms. Eason was accused of orchestrating a health care fraud scheme that resulted in the submission of over $63 million in false claims to Medicare and Florida Medicaid. In addition, Ms. Eason was sentenced to three years of supervised release. She has been ordered to pay a total of $14,985,876 in restitution, according to the Justice Department.
As the director of medical records for HCSN’s partial hospitalization program (PHP), Ms. Eason directed and oversaw the alteration and forgery of thousands of medical records used to support fraudulent claims submitted to Medicare and Medicaid. She directed therapists to create false documents and forged signatures on the documents. Many of the records were created months after the patient’s admission for purported PHP treatment. HCSN paid illegal kickbacks to the owners and operators of Miami-area assisted living facilities to obtain patient referral information, although Ms. Eason knew that many of these patients were ineligible for PHP.
PHP is a type of intensive treatment for serious mental illness. The evidence at trial suggested that HCSN was not providing effective PHP, however. Patients sometimes did no more than watch Disney movies, play bingo, and eat barbeque. These activities were omitted from the medical records.
Between 2004 and 2011, HCSN billed Medicare and Medicaid over $63 million for mental health services that the company allegedly provided.
False Claims Act Gives Insiders Tool to Fight Health Care Fraud
Whistleblowers are important allies in the government’s fight on Medicare and Medicaid fraud. It is important, though, that tipsters and informants understand their rights under the False Claims Act before they collaborate with the government. The experienced qui tam lawyers at Waters & Kraus provide skilled representation and counsel to tipsters and informants. Contact us by email or phone our whistleblower attorneys at 855.784.0268 to learn more about how we can assist you in this process.