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False Claims Act: Before Careful of Committing Fraud When You Submit Claims Under Medicare and Medicaid

above-the-bar-logo.jpgThe Justice Department just announced that the government is intervening in a whistleblower lawsuit against AseraCare Hospice (“AseraCare”) for violating the False Claims Act by misspending millions of dollars which was intended for Medicare recipients with less than 6 months to live, and using it on patients who were not terminally ill. AseraCare is a for profit business with about 65 hospice providers in 19 states.

For-profit companies like AseraCare, who care for hospice patients, receive money from Medicare only for Medicare recipients who are terminally ill. In other words, when AseraCare admits a Medicare patient for hospice care, that patient is not longer able to receive medical service that would help treat or cure his or her illness. The purpose of hospice care it to provide palliative care which is intended to relieve pain, symptoms or stress of terminal illness, which includes medical, social, psychological, emotional and spiritual services.

The government has charged AseraCare with knowingly submitting false claims to Medicare for patients receiving hospice care who were not terminally ill. Joyce White Vance, the U.S. Attorney for the Northern District of Alabama, stated that “Medicare benefits, including hospice benefits, are intended only for those individuals who are appropriately qualified.”

Two whistleblowers, Dawn Richardson, and Marsha Brown, who are former employees of AseraCare, originally filed this qui tam lawsuit under the False Claims Act. Since the government has intervened and taken over the lawsuit, the whistleblowers may by entitled to recover anywhere from 15% to 25% of the government’s recovery. Whether you are a patient, a former or current employee, or a competitor, you can bring an action on behalf of the government if you have knowledge of fraud being committed against the government.

Under the False Claim Act, a healthcare provider will be liable if he or she knowingly files a false or fraudulent claim for payment or approval to Medicare or any other governmental healthcare program or knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by a healthcare program. If AseraCare is found to be guilty, the government may recover treble damages as well as impose monetary penalties ranging from $5,500 to $11,000 per violation.

Medicare and Medicaid fraud are serious and costly violations of federal law which can also result in exclusion from participating in Medicare and Medicaid. If you think your healthcare company or medical practice has violated the False Claims Act, you must act quickly. Once you discover that you have been overpaid, you must notify the government as to why the overpayment occurred and return the overpayment within 60 days of your discovering it. Our attorneys have helped many health care providers resolve costly mistakes and avoid potential litigation. If you think you might have received an overpyamnet from Medicare or Medicaid, call our False Claims Attorneys at Villanueva & Sanchala at (800) 893-9645 to help you remedy any fraud before the government or a whistleblower brings an action against you.


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