The False Claims Act was created to prevent war profiteering against the government during the Civil War. But I want to underscore the word “profiteering” as it applies to anyone who unjustly enriches themselves through a government contract. One area that I have seen a tremendous growth of False Claims Act cases here in Mississippi is health care, specifically regarding nursing homes. It may not be intuitive that fraud involving nursing homes implicates government contracting laws, but the vast majority of home health care is paid for by two government programs, Medicare and Medicaid. As a result, fraudulent activities in the home health setting often end up defrauding the government and make this industry ripe for whistleblower claims under the False Claims Act.
The False Claims Act provides tremendous rewards—15% to 30% of the amount recovered by the government—to whistleblowers. It also protects those who engage in whistleblowing from retaliation such as termination, discipline, or other negative conduct. Because home health accounts for many millions of dollars in government contracts through Medicare and Medicaid each year, the reward for whistleblowers can be tremendous. Do you know about fraud in the home health care industry? Are you considering filing a whistleblower case? Call Barrett Law now at (800) 707-9577 if you think you may be a whistleblower.
Recent Positive Ruling for Home Health Care Whistleblower
On June 11, 2018, The Sixth Circuit Court of Appeals in United States ex rel. Marjorie Prather v Brookdale Senior Living Communities, Inc., et al., for Prather, the False Claims Act whistleblower. I have included a link to the entire case below if you would like to read it.
The Prather ruling is interesting for two reasons. First, it highlights how heavily regulated the home health care industry is. Second, it states that a knowing violation of those regulations can form the basis for a successful whistleblower claim under the False Claims Act.
One of the federal regulations governing home health care services, 42 C.F.R. §424.22(a)(2), states:
“[t]he certification of need for home health services must be obtained at the time the plan of care is established or as soon after that as possible and must be signed and dated by the physician who establishes the plan.”
“home-health agency to complete a physician certification of need after the plan of care is established, but…such a delay [is] acceptable only if the length of the delay is justified by the reasons the home-health agency provides for it.”
In a nutshell, a physician must sign and date a home health care client’s care plan before the company submits the bills for the care to the government, Prather reported to the government that her home health care company was not getting the appropriate signatures before submitting bills. She lost her initial case, and the district court found that her allegations were insufficient to substantiate a claim under the False Claims Act. The good news is that the 6th Circuit Court of Appeals disagreed, finding that her allegations of regulatory dishonesty created a sufficient basis for a claim. In False Claims Act terminology, the Court of Appeals found sufficient “materiality.”
What Should You Do if You are Considering a Whistleblower Claim?
Are you aware of fraud in the home health care industry? Are you considering filing a whistleblower case? Call Barrett Law now at (800) 707-9577 if you think you may be a whistleblower.
Experienced whistleblower lawyer Barrett can provide you with the advice you will need to file a successful False Claims Act case. Having expert legal advice by your side can mean the difference between receiving your share of a whistleblower reward and losing your career and livelihood. Call us today.
