Plaintiff Angela Ruckh filed the False Claims Act suit in 2011, naming Governor’s Creek and Marshall nursing facilities; management company, LaVie Management; LaVie Rehab; and CMC II, the new corporate owner of the facilities, as defendants.
Ms. Ruckh’s lawyer told Corporate Crime Reporter that his client started working for the companies to help train the nurses that fill out the forms, which are used to bill Medicare and Medicaid. The forms generate codes that determine how much Medicare owes a facility.
A lifelong nurse with years of experience caring for patients and involved in the Medicare billing process, Ms. Ruckh was astonished by the practices she witnessed at the LaVie companies.
“Every place she had worked before, it was all about caring for the patient. At LaVie, it was all about maximizing profits. It was a totally different culture,” her lawyer told Corporate Crime Reporter.
For instance, LaVie allegedly engaged in systematic fraud that “was encouraged by senior officers who established target reimbursement rates, offered employees financial bonuses for exceeding those rates, and actively encouraged employees to falsify statements and claims submitted” to the government health care programs, her complaint alleges.
She also allegedly witnessed the company treating Medicare and Medicaid patients with the exact same conditions differently because the reimbursements were more profitable for Medicare patients.
The federal government declined to intervene in the case, but Ms. Ruckh and her lawyers pressed on with it. Her lawyer told Corporate Crime Reporter that they were able to prove that “LaVie had a culture that was obsessed with money.”
“That culture led to false claims at 53 facilities throughout the state of Florida over a four year period from January 2008 to January 2012,” Ms. Ruckh’s lawyer told Corporate Crime Reporter, explaining that the facilities unlawfully “upcoded” the services on paperwork to maximize Medicare billings.
The jury award of $115 million automatically triples under the False Claims Act, meaning the U.S. government could collect $345 million, plus penalties, if the verdict stands. In False Claims Act cases in which the government declines to become involved, whistleblowers may be awarded up to 30 percent of any recovery.
Source: Corporate Crime Reporter