Healthcare and Pharma Cases

Hudson Valley Hematology Oncology Associates will pay the government $5.31 million to resolve allegations in a whistleblower lawsuit that it systematically billed Medicare and Medicaid for ineligible and non-existent services.

Between 2010 and 2015, Hudson Valley was allegedly involved in two different fraudulent schemes. On the one hand, it waived Medicare beneficiaries’ copayments and billed Medicare instead. On the other hand, it routinely billed both Medicare and Medicaid for services that were either not performed or not medically necessary.

Whistleblower Lucille Abrahamsen: Medical Coder Hudson Valley Employee

Hudson Valley’s wrongdoing was first brought to light by Lucille Abrahamsen, a resident of Highland, New York, who filed a lawsuit under the False Claims Act in April, 2014. Abrahamsen became aware of her employer’s improper billing practices while working for them as a medical coder....

Life Care will pay $145 million to resolve charges that it caused skilled nursing facilities (SNFs) to submit false claims to both Medicare and TRICARE for unnecessary rehabilitation services. The SNF giant, which operates over 200 facilities, was allegedly involved in a scheme to systematically increase its billings to government health programs TRICARE and Medicare. The allegations were first brought to light by two whistleblowers, Tammie Taylor and Glenda Martin, both former Life Care employees.

Spanning seven years, the alleged misconduct targeted a particular type of Medicare reimbursement, associated with patients who require extensive and frequent therapy. When a patient needs over 720 minutes of two types of skilled therapy per week, including one that is requires five times a week, their treatments qualify for Ultra High reimbursements from Medicare.

Whistleblowers Glenda Martin & Tammie Taylor Said Unnecessary Rehab Services

According to the whistleblower False Claims Act lawsuit filed by Glenda Martin and Tammie Taylor, in order to increase billings, Life Care had internal policies in place to ensure that the largest possible number of patients qualified for the Ultra High category....

A whistleblower lawsuit has accused the Visiting Nurse Service of New York (VNSNY) of defrauding Medicaid and Medicare and receiving millions of dollars for care ordered by doctors, which the patients never received. According to the allegations, VNSNY systematically billed for the full number of nursing and rehabilitation visits ordered by doctors, but patients received only a fraction of them.

The lawsuit was initiated by whistleblower Edward Lacey, VNSNY's former VP of Operations Improvement and Integration, who had been with the organization for 16 years. Investigations into fraudulent conduct are, however, nothing new for the healthcare provider Visiting Nurse Service of New York. In 2014, VNSNY paid the government $35 million to settle a lawsuit alleging that it had enrolled over 1,700 ineligible individuals into Medicaid plans.

Under the False Claims Act, whistleblowers such as Edward Lacey who have information about fraud against the government can file a lawsuit on the government's behalf and are entitled to a portion of any received damages and civil penalties. Whistleblower rewards range from 15 to 30% of the total recovery....

Sylvia Daniel, a former health information coder at Vibra Hospital of Southeastern Michigan, will receive a whistleblower award of at least $4 million after filing a qui tam lawsuit alleging the hospital billed Medicare for medically unnecessary services, the Department of Justice announced Wednesday. Vibra Healthcare LLC, a Mechanicsburg, Pennsylvania-based national hospital chain, has agreed to pay $32.7 million plus interest to resolve claims its facilities violated the False Claims Act.

“Medicare beneficiaries are entitled to receive care that is determined by their clinical needs and not the financial interests of healthcare providers,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, commenting on the settlement of Sylvia Daniel’s whistleblower lawsuit against Vibra Healthcare.

“All providers of taxpayer-funded federal healthcare services, whether contractors or direct billers, will be held accountable when their actions cause false claims for medically unnecessary services to be submitted.”...

The United States filed a False Claims Act lawsuit against Brentwood, Tennessee-based Vanguard Healthcare LLC., alleging the company submitted false claims to Medicare and TennCare, provided either non-existent or “grossly substandard” care for elderly patients in six of its Tennessee nursing homes, and forged signatures on required nursing facility Pre-Admission forms, the Department of Justice announced today.

Nursing Home Residents Suffer Non-Existent, Substandard Care

According to the False Claims Act lawsuit, between January 2010 and December 2015, six Vanguard Healthcare nursing homes exhibited ongoing staffing and medical supply shortages, failed to practice standard infection control procedures, failed to deliver prescribed medications, failed to follow physicians’ orders in caring for wounds, failed to practice proper pain management, gave “unnecessary and excessive” psychotropic medications to residents and used unnecessary physical restraints....

Louisville-based post-acute care provider, Kindred Health Care, Inc., has paid the largest penalty ever imposed by the Office of the Inspector General (OIG) for failing to comply with a corporate integrity agreement (CIA). The record penalty amounted to over $3 million, the Department of Health and Human Services’ (HHS) Inspector General Daniel R. Levinson announced today.

OIG Imposes CIA In Exchange for Exclusion from Medicare Program

Kindred Health Care provides hospice services for Medicare patients with life expectancies of six months or less. Patients receiving hospice care agree to cease curative care and only receive palliative care to lessen their symptoms....

In 2014, the federal government decided to intervene against Evercare, now known as Optum Palliative and Hospice Care, in two whistleblower lawsuits which alleged that the hospice care provider had claimed Medicare reimbursements for patients who were not eligible for the type of care they received.

Two years later, a settlement has been reached, by which Optum Palliative will pay the federal government $18 million to resolve the False Claims Act allegations, which were initiated by two former Evercare employees, whistleblowers Terry Lee Fowler and Lyssa Towl. The whistleblowers will receive a reward that could go as high as 30% of the multi-million dollar recovery.

Lyssa Towl and Terry Lee Fowler Whistleblower Suit Alleged Medicare Fraud

Hospice care is covered under Medicare for patients who are terminally ill, but Evercare billed the federal program for the care of elderly patients who, albeit often incurable, did not fulfill the requirements for Medicare's hospice benefits. In order to be eligible, a patient must have a life expectancy of six months or less....