April 8, 2013 — As Americans age, many prefer to live in their own homes as long as possible. To make that possible, and to contain rising hospital costs, Medicare offers benefits for home health care to patients recovering from an illness or injury. Unfortunately, some untrustworthy home health care providers bilk the system by submitting false claims to Medicare for services that were unnecessary or never provided. Home health care scams frequently come to light when insider employees use the U.S. False Claims Act to bring a lawsuit on the government’s behalf against the wrongdoers. Under the qui tam provisions of the statute, informants who are courageous enough to come forward are eligible to retain a portion of the government’s settlement or judgment.
False Claims Submitted to Medicare in Detroit Home Health Care Scam
In Detroit, a registered nurse has pleaded guilty in connection with a $24 million home health care Medicare fraud conspiracy. Beverly Cooper admitted her role in a Medicare scam involving three Michigan home health care companies: Accessible Home Care Inc., First Choice Home Health Care Services Inc., and Reliance Home Care LLC.
From 2006 to 2012, while working with the home health providers, Cooper falsified notes and other documents to support the companies’ false claims to Medicare. Cooper admitted that she signed notes for home nursing visits that were in fact made by unlicensed individuals or were not made at all. These documents were used to submit false claims to Medicare for home health care services that either were not medically needed or were not provided. When Michigan regulatory agencies inspected the home health care providers, Cooper and others took part in home health visits that were completely staged with phony patients, attempting to deceive inspectors into believing that the providers were legitimate.
As a result of the misconduct of Cooper and others, Medicare paid the unscrupulous home health providers in excess of $5.5 million.
Insider Employees Notify United States of False Claims Act Violations
The United States is often notified of False Claims Act violations involving falsified medical records by insider employees. Before alerting the government, conscientious informants deserve to understand their own rights. The whistleblower lawyers at Waters & Kraus offer tipsters the experienced legal representation they need in the fight against Medicare fraud. Contact us or call our whistleblower attorneys at 800.226.9880 to discuss the firm’s health care fraud practice.