Consumer Fraud

Alabama nurse receives $15 million whistleblower reward for exposing Medicare fraud

osha whistle Alabama nurse receives $15 million whistleblower reward for exposing Medicare fraudA Monroeville, Ala., nurse who filed a False Claims Act lawsuit against a home health care company will receive more than $15 million for her part in helping the U.S. recover $150 million in funds that she and others claim were fraudulently taken from Medicare and other health care programs.

April Brown filed her whistleblower lawsuit in a federal court in Birmingham in 2010, alleging that her employer, Baton Rouge, Louisiana-based Amedisys Inc. billed for health care services that she hadn’t provided or were provided but not medically necessary.

Ms. Brown, a home health care nurse in the Monroeville area, alleged that patients were also made to look sicker than they actually were in paperwork submitted to Medicare. Amedisys nurses had to check off services provided on computerized forms during patient visits. The company, however, set up the forms so that patients were always coded for the highest level of care, and the forms didn’t truthfully represent the patients’ condition, often showing they were sicker than they really were and in some cases not even homebound.

Amedisys fired Ms. Brown after she questioned the company’s practices, and she was the first of six nurses throughout the country to file a whistleblower lawsuit under the qui tam provisions of the False Claims Act. All of the lawsuits against Amedisys, which operates in 37 states, were consolidated in a Pennsylvania federal court. They alleged the fraud occurred between 2008 and 2010.

According to the U.S. Justice Department, company management put pressure on nurses and therapists to provide care based on the financial benefits to Amedisys rather than the patients’ needs.

The Justice Department also alleged that Amedisys violated the Anti-Kickback Statute and Stark Statute by maintaining improper financial relationships with referring physicians. Such arrangements are designed to put profits over the medical needs of patients and can diminish the quality of care patients receive.

“Amedisys made false Medicare claims, depriving the American taxpayer of millions of dollars and unlawfully enriching Amedisys,” Joyce Vance, U.S. Attorney for the Northern District of Alabama, said in a statement, adding that enforcement efforts had “secured the return of $150 million to the taxpayers.”

As a reward, whistleblower plaintiffs receive 10 to 30 percent of any recovery they help the U.S. government make under the False Claims Act. The total reward paid to the seven plaintiffs in this case was $26 million. Ms. Brown received $15 million as her share.

Sources:

U.S. Justice Department