Whistleblower

Health care providers who submit Medicare and Medicaid claims containing false statements also may be liable under the False Claims Act.

Examples

Employees and a pharmaceutical corporation were sued under the False Claims Act for forging doctors' signatures on certificates of medical necessity and beneficiaries' signatures on assignment forms for surgical dressings and for ostomy and urostomy supplies as well as billing for supplies never sent. Settlement $3.4 Million.

Five defendants were involved in a scheme which fraudulently billed Medicare about $5.2 million for oxygen concentrators, nebulizers, medications and tests and for paying physicians for prescriptions that were sold to two medical supply companies and a laboratory to use in billing Medicare. Verdict: Three of the defendants were ordered to pay $2.3 million in restitution, and sentenced to 41, 46 and 51 months in jail One of the company owners and a physician who had billed for house calls he did not make were convicted and given prison terms as well.

A home health agency forged physicians' signatures on certification forms, directed employees to alter nurses' notes, added services to Medicare claims, use the forged forms, made false ledger entries and carried "ghost" employees on payroll records. Defendants were sentenced to pay $1.3 million in fines, restitutions and special assessments. Verdict: $1.3 Million.

A medical equipment company submitted claims for more than a year for lymph edema pumps under a code for which the pumps did not meet specifications. Settlement $1.5 million.

The two principal executive officers of a home health services agency engaged in massive fraud by falsifying and altering training certificates and other credentials of personal care aides and home health care aides employed by the company. The two individuals and their corporation were excluded for 15 years from participation in Medicare and state health care. The corporation pled guilty to falsifying personnel files and grand larceny. It agreed to pay $4.75 million to resolve liabilities under the civil monetary penalties law, the False Claims Act and New York state statutes.