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False Claims Act Update: Whistleblowers Recover Millions for Exposing Healthcare Fraud

Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for above-the-bar-logo.jpgOdyssey HealthCare, Inc. (“Odyssey”) recently agreed to settle allegations under the False Claims Act by agreeing to pay the government $25 million for charges of Medicare fraud. As part of the settlement, the company has also agreed to enter into a five year corporate integrity agreement with the U.S. Department of Health and Human Services. Odyssey is one the nation’s largest providers of hospice care and operates in about 27 states, including New Jersey. In 2010, Odyssey was bought by the nation’s largest home health care service firm, Gentiva Health Services.

One of the whistleblowers in this case, Jane Tuchalski, a former company nurse, brought the False Claims Act violations to light. These same allegations of committing Medicare fraud were originally raised in three other lawsuits against Odyssey. All the whistleblowers will receive payments of more than $4.6 million for their part in whistleblowing and bringing lawsuits against Odyssey. If you have observed Medicaid or Medicare fraud being committed against the government at your workplace, call our attorneys to help you figure out if you have a claim under the False Claims Act.

The U.S. Department of Justice had charged Odyssey with submitting false claims to the Medicare program for continuous home care services that were either not necessary or were not performed in accordance with Medicare requirements between January 2006 and January 2009. The lawsuit alleged Odyssey with having a pattern of enrolling and recertifying non-terminally ill patients and billing for continuous care that wasn’t necessary or reasonable.

Medicare provides benefits to cover hospice care for terminally ill patients who choose palliative treatment for a terminal illness. Patients can only elect palliative hospice care if they have a diagnosis giving them 6 months or less to live if their disease runs its normal course. Most hospice care is billed at a routine care level. In cases of continuous home care, Medicare pays for higher levels of care. However, this type of care is only available when a patient is having an acute crisis with symptoms which can only be controlled at home with the help of skilled nurses. Continuous care services have the highest reimbursement rate available to a hospice and the amount is several hundred dollars a day more than the amount billed for routine services.

Daniel R. Levinson, Inspector General of the Department of Health and Human Services, stated that the “federal government pays for the hospice care of Medicare patients to make them more comfortable during the last months of their lives. . . Odyssey used a diagnosis of terminal illness as an opportunity to bill taxpayers for unnecessary services.”

Odyssey’s fraudulent billing to make millions off of terminally ill patients is shameful. Had it not been for the whistleblowers, it would have gone undetected. The qui tam provision of the False Claims Act is one of the government’s greatest weapons in detecting fraud. It uses the help of private individuals to report the fraud and then rewards them with a percentage of the recovery for their help. Since fraud against the government is basically a theft of taxpayer monies, it is in the interest of every taxpayer to help in the government’s fight. If you know of fraud being committed against the government at your place of employment, contact our Whistleblower Attorneys at Villanueva & Sanchala at (800) 893-9645 help you determine if you have a claim under the False Claims Act.

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