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If I Work In A Nursing Home Where I Suspect Fraud, Can I File A Qui Tam or Whistleblower Lawsuit?

Yes. Under the Federal Civil False Claims Act (31 U.S.C., Section 3729), private citizens act on behalf of the Federal or State Government to bring an action against government contractors or any company who acts fraudulently with government funds. Under the False Claims Act, a qui tam lawsuit entitles individuals employed by the entity guilty of fraud to bring a lawsuit for fraud-related damages against the offending company.

Fraud Is Rampant In The Nursing Home Industry

Many nursing homes and medical service providers have turned to illegal practices to boost their bottom line.  By some accounts, up to 10% of Medicare charges have some some type of fraud. Examples of fraud-related qui tam cases in the nursing home setting include:

  • Ghost billing- billing for patients that do not exist
  • Using inferior medicine or medical equipment, yet billing the government for the premium services
  • Billing more than once for the same service
  • Billing for services not performed
  • Offering free items or services in exchange for a Medicare or Medicaid number
  • Waiving co-payments routinely
  • Someone other than the physician completing the Certificate of Medical Necessity

Qui Tam Lawsuits Can Be Lucrative To Those Who Report Fraud

The government recognizes that fraud in the medical field leads increased costs and inefficiency.  Further, the government realizes that they have the best chance of discovering medical fraud by providing a financial incentive to those who witness illegal acts.

If you uncover a situation where you believe the government is being defrauded, qui tam whistleblowers have the right to recover between 15 and 30 percent of the total amount recovered from the fraud lawsuit.   The damages related to qui tam lawsuit can be substantial as the party initiating the lawsuit can sue for triple the amount of actual fraud damages plus civil penalties ranging between $5,500 to $11,000 per claim.

For example, if a nursing home charged Medicare $50 per physical therapy sessions for 1,000 sessions, it never provided to residents, the potential damages under a qui tam theory could be $11,150,000 ($50 x 1,000 = $50,000 x 3 = $150,000 + 1,000 x $11,000).  In this case, the whistleblowing employee could be entitled to $3,345,000.

In the year 2003 alone the amount of U.S. recoveries in qui tam cases totaled 7.8 billion, with whistleblowers recovering a total of 1.3 billion.  If you suspect any person, company or entity involved in defrauding the government, you should contact an experienced qui tam lawyer.

At Rosenfeld Injury Lawyers, not only do we have experience handling qui tam matters, but we have the unique advantage of understanding the inner workings of nursing homes and other medical facilities having litigated many cases against these entities.  We put this experience to work for you.

Lastly, qui tam cases require you to act quickly. In many situations only the first individual to file a claim will have a right to compensation.

Examples Of Qui Tam Related Recoveries:

  • $355,000,000 AstraZeneca
  • $334,000,000 Amerigroup
  • $325,000,000 HealthSouth
  • $257,000,000 Bayer
  • $155,000,000 Medco Health
  • $49,000,000 Pfizer
  • $26,000,000 Key West Pharmacy

Qui Tam Web Resources:

FALSE CLAIMS ACT CASES: GOVERNMENT INTERVENTION IN QUI TAM (WHISTLEBLOWER) SUITS

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  • Ian Shepard

    Grasmere Place is a nursing home, which staff are guilty of neglect and abuse. Grasmere Place allows active smoking in their facility. The officials of the chicago Public Health Department has been in the infested facility and has recommended that the smoking cease in the building. Unfortunately, the officials at Grasmere has DISREGARD the order and continues to allow second hand smoking in the building. The residents that are nonsmokers are at risk for respiratory infections, COPD, and lung cancer. Someone needs to shut this facility down permanently.

  • Current Employee

    I work for a nursing facility in Oklahoma where the owners also own another nursing facility in Oklahoma as well. In the facility I work in bills are not paid (which the company has received medicare funds to provide for the residents…so wouldn’t that be medicare fraud?). The grocery bill was not being paid or not paid in full so eventually the grocery store owner cut off the nursing home from charging. When that happened the employees had to buy food from money out of their own pocket in order for the residents to have something to eat. Medical supplies are scarce or non existent due to the bill not being paid. The residents do not have money in their trust accounts because the owners have taken it all out to pay employee wages and other misc. things. Only when a family member questions the amount that is supposed to be in the residents account does the money ‘magically’ appear. Insurance and garnishments are being taken out of the employees paychecks every payday and not being paid. Physical therapy (with the physical therapist being the owners wife) does not provide adequate or any physical therapy to the residents. In one instance, a resident came into the facility for physical therapy after suffering a heart attack and never regained his strength after 6 months of being in the facility. He finally demanded to be sent to a nearby rehab unit where he stayed 2 weeks and WALKED out of that facility and is now home with his family. I, along with others, have turned in this information to the Oklahoma Medicare fraud unit, the Oklahoma Labor Board, the Oklahoma DHS and they have ALL stated that there is nothing they can do to help. Hmmmm…sounds like pockets are being lined doesn’t it. Therefore, why would anyone want to try to do the right thing and get help for these residents when NOTHING will be done…except for that employee losing their job if their employer should ever find out. It’s VERY FRUSTRATING!

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