In a settlement agreement with the U.S. Attorney, the operator of 18 nursing homes in Tennessee and Mississippi has agreed to reimburse the government $ 2 million related to allegations of fraudulent billing practices at its facilities. Further, according to the terms of the settlement, the nursing home will implement an internal fraud-monitoring program and will train its employees on compliance with Medicare rules.
The Medicare fraud settlement was achieved after an operations manager confronted his employer, Vanguard Healthcare about its illegal billing practices at skilled nursing facilities that it owned. Soon after the charges were made, the company turned around and fired the manager.
Still concerned about the illegal practices, the ex-employee initiated a lawsuit against Vanguard under provisions of the False Claims Act. As in other healthcare fraud lawsuits, soon after the individual’s claims were substantiated— the federal government joined in the suit. In particular, the suit focused on Vanguard’s alleged double billing of services and submitting fraudulent Medicare claims for patients who were not eligible for the program.
Sadly, as some nursing homes see their budgets get cut, some operators have looked towards Medicare or Medicaid fraud. In Tennessee alone, federal prosecutors have recovered more than $100 from healthcare facilities that have illegally billed the government for services that were never actually provided or provided by staff not qualified to provide the services.
In addition to reimbursing tax-payer dollars, The False Claims Act also allows the individual who initiates the case (frequently referred to as the Whistleblower) to share in a percentage of the recovery from the illegal enterprise. Depending on the circumstances, the whistleblower may recover between 10 to 30 percent of the gross recovery.
Brentwood-based Vanguard to pay $2 million in whistleblower fraud lawsuit, Tennessean.com November 8, 2011